Attenuation arrangement for implantable medical device

ABSTRACT

An implantable medical device includes at least one conductive element and an associated attenuation arrangement to attenuate MRI energy.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S patent application Ser. No.16/092,387, filed Oct. 9, 2018, which is a National Phase Application ofPCT Application No. PCT/US2017/032107, entitled “ATTENUATION ARRANGEMENTFOR AN IMPLANTABLE MEDICAL DEVICE,” filed May 11, 2017, which claims thebenefit of U.S. Provisional Patent Application No. 62/334,774, entitled“ATTENUATION ARRANGEMENT FOR AN IMPLANTABLE MEDICAL DEVICE,” filed May11, 2016, the entire teachings of each of which are incorporated hereinby reference.

BACKGROUND

Modern medicine has provided previously unimaginable abilities, such asinternal imaging. One type of internal imaging includes magneticresonance imaging. Other modern technologies include implantable medicaldevices, some types of which may not be compatible with such internalimaging.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram including an end view schematically representing apatient within an MRI field, according to one example of the presentdisclosure.

FIG. 2 is a block diagram including a side view schematicallyrepresenting an implantable stimulation system including an associatedattenuation arrangement, according to one example of the presentdisclosure.

FIG. 3 is a block diagram schematically representing a block diagram ofa monitor, according to one example of the present disclosure.

FIG. 4 is a diagram schematically representing an implantablestimulation system as deployed within a patient, according to oneexample of the present disclosure.

FIG. 5A is a block diagram schematically representing an attenuationarrangement relative to an MRI-energy field, according to one example ofthe present disclosure.

FIG. 5B is a block diagram schematically representing an attenuationarrangement in association with a lead assembly, according to oneexample of the present disclosure.

FIG. 5C is a block diagram schematically representing an attenuationarrangement in association with a lead assembly, according to oneexample of the present disclosure.

FIG. 5D is an end sectional view schematically representing anattenuation arrangement in association with the lead assembly, accordingto one example of the present disclosure.

FIG. 6B is a perspective view schematically representing an implantablelead assembly including a FPE assembly in an un-wound configuration,according to one example of the present disclosure.

FIG. 6C is a perspective view schematically representing an implantablelead assembly including a FPE assembly and omitting an elongate supportmember, according to one example of the present disclosure

FIG. 7A is a sectional view schematically representing a FPE assembly,according to one example of the present disclosure.

FIG. 7B is a sectional view schematically representing a FPE assembly,according to one example of the present disclosure.

FIG. 7C is a sectional view schematically representing a FPE assemblyincluding two signal conductive elements, according to one example ofthe present disclosure.

FIG. 7D is a sectional view schematically representing a FPE assemblyincluding at least one shield conductive element, according to oneexample of the present disclosure.

FIG. 7E is a sectional view schematically representing a FPE assemblyincluding two shield conductive elements, according to one example ofthe present disclosure.

FIG. 8A is a top view schematically representing a portion of a FPEassembly including a conductive element arranged as a mesh on aninsulator, according to one example of the present disclosure.

FIG. 8B is a perspective view schematically representing the portion ofthe FPE assembly in FIG. 8A, according to one example of the presentdisclosure.

FIG. 9 is a perspective view schematically representing a portion of aFPE assembly including a conductive element forming a three-dimensional(3D) coil structure relative to an insulator, according to one exampleof the present disclosure.

FIG. 10 is a sectional view schematically representing a FPE assembly ofan implantable lead assembly, according to one example of the presentdisclosure.

FIG. 11 is diagram including a sectional view schematically representinga FPE assembly of an implantable lead assembly and a block diagram of animplantable pulse generator to which the implantable lead assembly iscoupled, according to one example of the present disclosure.

FIG. 12 is a sectional view schematically representing a FPE assemblyincluding an RF antenna, according to one example of the presentdisclosure.

FIG. 13 is a top view schematically representing an array of signalconductive elements in one layer of a FPE assembly, according to oneexample of the present disclosure.

FIG. 14 is a top view schematically representing an array of signalconductive elements in one layer of a FPE assembly, according to oneexample of the present disclosure.

FIG. 15 is a sectional view schematically representing a FPE assemblyincluding an exposed shield conductive element, according to one exampleof the present disclosure.

FIG. 16 is a sectional view schematically representing a FPE assemblyincluding exposed vias coupled to a shield conductive element, accordingto one example of the present disclosure.

FIG. 17A is a top view schematically representing a portion of a FPEassembly including a signal conductive element arranged in a meshpattern, according to one example of the present disclosure.

FIG. 17B is a top view schematically representing a FPE assemblyincluding a signal conductive element arranged in a curved pattern,according to one example of the present disclosure.

FIG. 18A is a block diagram schematically representing a portion of alead assembly formed as a FPE assembly and including an associatedattenuation arrangement, according to one example of the presentdisclosure.

FIG. 18B is a block diagram schematically representing a lead assemblyformed as a FPE assembly and including an associated attenuationarrangement, according to one example of the present disclosure.

FIG. 18C is a sectional view of FIG. 18B as taken along lines 18C-18Cand schematically representing a cuff electrode, according to oneexample of the present disclosure.

FIG. 18D is a sectional view schematically representing a FPE assemblyincluding a contact electrode, according to one example of the presentdisclosure.

FIG. 18E is an isometric view schematically representing a cuffelectrode incorporating a FPE assembly, according to one example of thepresent disclosure.

FIG. 18F is a sectional view as taken along lines 18F-18F of FIG. 18Eand schematically representing a cuff electrode incorporating a FPEassembly, according to one example of the present disclosure.

FIG. 18G is a sectional view as taken along lines 18G-18G of FIG. 18Eand schematically representing a cuff electrode incorporating a FPEassembly, according to one example of the present disclosure.

FIG. 18H is an isometric view schematically representing a cuffelectrode incorporating a FPE assembly, according to one example of thepresent disclosure.

FIG. 18I is a sectional view as taken along lines 18I-18I of FIG. 18Hand schematically representing a cuff electrode incorporating a FPEassembly, according to one example of the present disclosure.

FIG. 18J is an isometric view schematically representing a FPE assemblyformed as a cuff electrode, according to one example of the presentdisclosure.

FIG. 18K is a sectional view as taken along lines 18K-18K of FIG. 18Jand schematically representing a FPE assembly formed as a cuffelectrode, according to one example of the present disclosure.

FIG. 18L is an isometric view schematically representing a FPE assemblyformed as a cuff electrode, according to one example of the presentdisclosure.

FIG. 18M is a sectional view as taken along lines 18M-18M of FIG. 18Land schematically representing a FPE assembly formed as a cuffelectrode, according to one example of the present disclosure.

FIG. 18N is an isometric view schematically representing a FPE assemblyformed as a cuff electrode, according to one example of the presentdisclosure.

FIG. 18O is a sectional view as taken along lines 18O-18O of FIG. 18Nand schematically representing a FPE assembly formed as a cuffelectrode, according to one example of the present disclosure.

FIG. 19A is a view schematically representing arrays of circular-shapedconductive loops in a portion of a lead, according to one example of thepresent disclosure.

FIG. 19B is a sectional view schematically representing at least oneconductive loop, according to one example of the present disclosure.

FIG. 19C is a sectional view schematically representing array ofconductive loops, according to one example of the present disclosure.

FIG. 19D is a sectional view schematically representing array ofconductive loops and a capacitive structure, according to one example ofthe present disclosure.

FIG. 19E is a view schematically representing an array ofrectangular-shaped conductive loops in a portion of a lead, according toone example of the present disclosure.

FIG. 19F is a view schematically representing an array of overlapping,circular-shaped conductive loops in a portion of a lead, according toone example of the present disclosure.

FIG. 19G is a view schematically representing an array of integratedpassive devices in a portion of a lead, according to one example of thepresent disclosure.

FIG. 19H is a view schematically representing arrays of capacitivestructures in a portion of a lead, according to one example of thepresent disclosure.

FIG. 19I is a view schematically representing at least one array ofcapacitive structures in a portion of a lead, according to one exampleof the present disclosure.

FIG. 20A is a side sectional view schematically representing anattenuation arrangement external to a lead, according to one example ofthe present disclosure.

FIG. 20B is a side sectional view schematically representing anattenuation arrangement at least partially external to a lead, accordingto one example of the present disclosure.

FIG. 20C is a side sectional view schematically representing anattenuation arrangement within a lead, according to one example of thepresent disclosure.

FIG. 20D is an end sectional view schematically representing anattenuation arrangement within a lead, according to one example of thepresent disclosure.

FIG. 20E is side sectional view schematically representing a coilstructure, according to one example of the present disclosure.

FIG. 20F is an isometric view schematically representing a coilstructure, according to one example of the present disclosure.

FIG. 20G is a diagram schematically representing an attenuationarrangement, according to one example of the present disclosure.

FIG. 21A is a perspective view schematically representing an implantablelead assembly including a FPE assembly in a helically woundconfiguration about an elongate support member and extending within anouter flexible tubular insulator, according to one example of thepresent disclosure.

FIG. 21B is a perspective view schematically representing an implantablelead assembly including the FPE assembly of FIG. 21A and including asecond FPE assembly in a helically wound configuration as an externalshield, according to one example of the present disclosure.

FIG. 21C is a perspective view schematically representing an implantablelead assembly including a first FPE assembly of FIG. 21B and includingan external shield in which a third FPE assembly has helical windings inan opposite orientation relative to the helical windings of the secondFPE assembly, according to one example of the present disclosure.

FIG. 21D is partial top plan view schematically representing theopposite orientation of the helical windings of the respective secondand third FPE assemblies, according to one example of the presentdisclosure.

FIG. 21E is a perspective view schematically representing an implantablelead assembly including a first FPE assembly of FIG. 21B and includingan external shield in which a third FPE assembly has helical windings ingenerally the same orientation relative to the helical windings of asecond FPE assembly, according to one example of the present disclosure.

FIG. 21F is partial top plan view schematically representing thegenerally same orientation of the helical windings of the respectivesecond and third FPE assemblies, according to one example of the presentdisclosure.

FIG. 21G is partial top plan view schematically representing a FPEassembly including overlapping windings, according to one example of thepresent disclosure.

FIG. 21H is a perspective view schematically representing an implantablelead assembly including the FPE assembly of FIG. 21A and furtherincluding an external coil shield, according to one example of thepresent disclosure.

FIG. 22A is a perspective view schematically representing an implantablelead assembly including at least the FPE assembly of FIG. 21A, accordingto one example of the present disclosure.

FIG. 22B is a perspective view schematically representing an implantablelead assembly including a FPE assembly extending within a lumen of anouter flexible tubular insulator, according to one example of thepresent disclosure.

FIG. 23 is a perspective view schematically representing an implantablelead assembly including the lead assembly of FIG. 22B and furtherincluding a second FPE assembly in a helically wound configuration as anexternal shield, according to one example of the present disclosure.

FIG. 24 is a perspective view schematically representing an implantablelead assembly including the lead assembly of FIG. 22B and furtherincluding at least an external coil shield, according to one example ofthe present disclosure.

FIG. 25 is a perspective view schematically representing an implantablelead assembly including a FPE assembly in a helically woundconfiguration about a lead, according to one example of the presentdisclosure.

FIG. 26 is a perspective view schematically representing one exampleimplementation of the lead of FIG. 25, according to one example of thepresent disclosure.

FIG. 27 is a sectional view schematically representing one exampleimplementation of a co-radial configuration of a pair of signalconductive elements, according to one example of the present disclosure.

FIG. 28 is a perspective view schematically representing an implantablelead assembly including the lead assembly of FIG. 26 and furtherincluding at least an external coil shield, according to one example ofthe present disclosure.

FIG. 29 is a sectional view schematically representing two signalconductive elements arranged side-by-side within a body of a lead,according to one example of the present disclosure.

FIG. 30 is a sectional view schematically representing one exampleimplementation of a coaxial configuration of a pair of signal conductiveelements within a body of a lead, according to one example of thepresent disclosure.

FIG. 31A is a perspective view schematically representing an implantablelead assembly including the lead assembly of FIG. 25 and furtherincluding an outer flexible tubular insulator having windows, accordingto one example of the present disclosure.

FIG. 31B is a sectional view as taken along lines 31B-31B of FIG. 31Aand schematically representing a conductive protrusion relative to awindow of the outer flexible tubular insulator, according to one exampleof the present disclosure.

FIG. 32 is a perspective view schematically representing an implantablelead assembly including a lead and an external coil shield, according toone example of the present disclosure.

FIG. 33 is a perspective view schematically representing an implantablelead assembly including the lead assembly of FIG. 32 and furtherincluding an outer flexible tubular insulator having windows, accordingto one example of the present disclosure.

FIG. 34 is a flow diagram schematically representing a method involvingan attenuation arrangement, according to one example of the presentdisclosure.

FIG. 35 is a flow diagram schematically representing a method involvingan attenuation arrangement, according to one example of the presentdisclosure.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings which form a part hereof, and in which is shown byway of illustration specific examples in which the disclosure may bepracticed. It is to be understood that other examples may be utilizedand structural or logical changes may be made without departing from thescope of the present disclosure. The following detailed description,therefore, is not to be taken in a limiting sense. It is to beunderstood that features of the various examples described herein may becombined, in part or whole, with each other, unless specifically notedotherwise.

In at least some examples, an implantable medical device includes atleast one conductive element and an associated attenuation arrangementto attenuate radiofrequency (RF) energy relative to at least the atleast one conductive element. In some examples, the RF energy comprisesmagnetic resonance imaging (MRI) energy.

In some examples, in a first aspect, the attenuation arrangement candissipate RF energy in the proximity of the at least one conductiveelement, such as but not limited to, conductors within a lead of a leadassembly.

In some examples, in a second aspect, the attenuation arrangement mayreduce coupling of RF energy onto the at least one conductive element(e.g. lead conductors). In one aspect, such reduced coupling may reduceRF power dissipated into tissue at contact electrodes (connected to theat least one conductive element) such that energy dissipated tosurrounding tissues via the contact electrodes may be reduced to a knownsafe level.

In some examples, the first aspect and the second aspect can be pursuedindependently while in some examples, the first and second aspects arepursued together.

It will be understood that in some examples, attenuating RF energy mayinvolve aspects in addition to, instead of, and/or in cooperation withthe above-mentioned first and second aspects.

Via the attenuation arrangement in at least some examples of the presentdisclosure, an implantable medical device can be constructed in a mannerwhich may reduce the number of components, which may simplifymanufacturing operations, and which may increase the ability to reliablycontrol target design parameters. Such target design parameters include,but are not limited to, capacitive coupling between conductors, thebody, and other elements.

These examples, and additional examples, are described in associationwith at least FIGS. 1-35.

FIG. 1 is a diagram including an end view schematically representing apatient within an MRI field, according to one example of the presentdisclosure. As shown in FIG. 1, a patient environment 50 includes an MRIdevice 52 which produces an MRI field 54 for scanning a patient 60 toobtain internal images. Implanted within the patient 60 is animplantable medical device (IMD) 62. In some examples, the IMD 62comprises at least one conductive element suitable for conductingelectricity for informational, diagnostic, and/or therapeutic purposes.

An attenuation arrangement 74 is associated with the IMD 62 to attenuateenergy from the MRI field 54 relative to the IMD 62. Via the attenuationarrangement, the IMD 62 may be deemed to be MRI-compatible or anMRI-conditional device such that a patient having an IMD 62 may bepermitted to receive an MRI scan instead of being excluded from such MRIscanning. More specific aspects of the attenuation arrangement 74 arefurther described in association with at least FIGS. 2 and 5A, andthroughout examples of the present disclosure.

It will be understood that in some examples, the MRI device 52 isconsidered representative of other types of imaging, diagnostic, orinterventional devices which produce radiofrequency fields orelectromagnetic fields for which the attenuation arrangement 74 can actto attenuate energy from those devices relative to the IMD 62.

In some examples, the IMD 62 forms part of a system having at least somecomponents implanted with patient 60 with such components including, butnot limited to, the IMD 62. Moreover, it will be understood that in someexamples the IMD 62 comprises a singular component while in someexamples, the IMD 62 comprises at least two components which areseparate but which are physically and/or electrically coupled together,either directly or indirectly.

FIG. 2 is a block diagram 100 schematically representing one IMD 62implemented as implantable system 76, according to one example of thepresent disclosure. As shown in FIG. 2, in some examples system 76includes lead 72 interposed between electrode 102 and a pulse generator104. The lead 72 has a first end 103 coupled relative to electrode 102and an opposite second end 105 coupled relative to pulse generator 104.In some examples, such coupling includes both a mechanical connectionand an electrical connection.

As further shown in FIG. 2, the attenuation arrangement 74 is associatedwith at least lead 72, as represented by zone A. In some examples, theattenuation arrangement 74 is further associated with electrode 102 (asrepresented by zone B) and/or further associated with pulse generator104, as represented by zone C shown in FIG. 2.

In some examples, the attenuation arrangement 74 is coextensive with atleast electrode 102. In one such example, as described later inassociation with at least FIG. 18B, at least a portion of theattenuation arrangement is embodied in a flexible printed electronic(FPE) assembly which is coextensive with at least the electrode 102. Insome examples, a portion of the attenuation arrangement is separatefrom, and independent of, the FPE assembly. Via such arrangements,attenuation can be provided for electrode 102 which may be in directcontact with body tissues (e.g. a nerve or muscle), such as might occurfor a neurostimulation lead for cardiac tissues, cranial tissues, nervesfor treating sleep disordered breathing (SDB) such as obstructive sleepapnea. The attenuation arrangement 74 may minimize unwanted RF powerdeposition and heating of the electrode 102 thereby may prevent tissuedamage that might otherwise occur in the absence of minimizing such heatvia the attenuation arrangement 74.

In some examples, the attenuation arrangement 74 provides protection forsome types of electrodes 102 which do not have stimulation as theirprimary function or which do not perform any stimulation. For instance,some electrodes 102 are used primarily for or exclusively for sensing.Accordingly, in some examples, the attenuation arrangement 74 mayprotect the sensing electrode 102 from potential damage or interferencefrom the MRI-energy/field. This protective functionality also may beimplemented when the sensing electrode 102 includes some form ofcircuitry beyond a mere conductive element, such as when a simpleconductive element (defining electrode 102) is replaced with anaccelerometer-based sensor, pressure sensor, etc.

In some examples, attenuation arrangement 74 is associated exclusivelywith lead 72, and not associated with electrode 102 and/or pulsegenerator 104.

In some examples, other configurations can be employed. For instances,in some examples attenuation arrangement 74 is associated exclusivelywith electrode 102 and not with lead 72 while in some examples,attenuation arrangement 74 is associated exclusively with pulsegenerator 104.

In other instances, attenuation arrangement 74 is associated withelectrode 102 and pulse generator 104 but not with lead 72, such as whenwireless communication and coupling exists between electrode 102 andpulse generator 104.

It will be further understood that in some examples, one of thecomponents (72, 102, 104) of system 76 can be external to the patient'sbody, and therefore may be operatively decoupled from the implantedcomponents of the system 76 such that the attenuation arrangement 74 isnot employed for those external components of system 76.

In some examples, electrode 102 can function as a stimulation electrodeand/or a sensor electrode 102. In some examples, system 76 includesmultiple such electrodes 102. In some instances of having multipleelectrodes, some electrodes 102 are dedicated to sensing while someelectrodes are dedicated to stimulation.

In some examples, system 76 includes a dedicated sensor monitor 110(FIG. 3) in place of pulse generator 104 or in addition to pulsegenerator 104, such that the attenuation arrangement 74 is associatedwith sensor monitor 110. It will be understood that pulse generator 104can include sensor monitor functionality even in the absence of aseparate, dedicated sensor monitor 110.

In some examples, monitor 110 can automatically sense or detect a MRsignal and in response, may cause IPG 104 to transition into a specialprotection mode.

In some examples, additional electrodes 102 may be positioned along alength of lead 72.

In some examples, lead 72 is flexible yet is equipped to have sufficientpushability, steerability, torquability, flex resistance, etc. to beadvanced and maneuvered within and through a patient's body viasubcutaneous tunneling, transvenous delivery, and/or percutaneousaccess.

In some examples, lead 72 comprises an assembly of multiple componentsand accordingly may sometimes be referred to as a lead assembly 73.Moreover, as described later throughout the present disclosure, in someexamples, at least some portions of such a lead assembly 73 may beimplemented as a flexible printed electronic (FPE) assembly.

In some examples, forming at least a portion of the lead and/or othercomponents (e.g. IPG 104, electrode(s) 102) via the FPE assembly mayprovide the ability to control the structure of the lead (and/or othercomponents) and any associated attenuation arrangements more finely,more precisely, at a lower cost, and/or in a smaller package thannon-FPE-based lead construction. Moreover, in some examples,constructing leads (and/or other components) with associated attenuationarrangements may enable increasing a density of a number and/or type ofconductive features within a given volume within an implantable medicaldevice, such as a lead. In some examples, a lead (and/or othercomponents) constructed via a FPE assembly may have a cross-sectionalarea at least one order of magnitude less than a cross-sectional area ofa non-FPE-based lead. In some examples, a lead (and/or other components)constructed via a FPE assembly may enable achieving the desiredfunctionality while utilizing a volume of conductive material which isat least one order of magnitude less than a volume of conductivematerial used in non-FPE construction.

In some examples, the lead 72 and pulse generator 104 may be permanentlycoupled together, i.e. combined to act as a single component. In someexamples, this single component also may comprise at least one electrode102 coupled to the lead 72. In some examples, the combined lead 72 (andelectrode(s) 102) and pulse generator 104 are embodied as amicro-element in which at least both the lead 72 and pulse generator 104are sized to be implanted within a single region of the body, such as ahead-and-neck region. In some such examples, the combined lead 72 (withelectrode(s) 102) and pulse generator 104 are sized for percutaneousimplantation at a single site and/or are sized for transvenousimplantation.

In some such examples, the permanently coupled IPG 104 and lead 72 maybe wholly or partially constructed via at least some aspects of an FPEassembly according to at least some of the examples described inassociation with FIGS. 1-35 throughout the present disclosure.

In some examples, portions of an implantable medical device 62, such assystem 76, which may be exposed to contact with bodily tissues and/orfluids, are made of biocompatible material and/or coated with abiocompatible material. In some examples, the biomaterial comprises aplatinum/iridium material or a platinum black-based material. Forinstance, electrode 102 and/or an external surface of IPG 104 mayinclude at least some portions made of such biocompatible materialsand/or coating.

In some examples, at least some portions of an implantable medicaldevice 62 (e.g. system 76) and/or attenuation arrangement 74 are madefrom a flexible printed electronics (FPE) assembly, as further describedbelow and throughout examples of the present disclosure. In some suchexamples, the exposed electrically conductive portions of such a FPEassembly and/or of attenuation arrangement 74 (e.g. those portionsexposed to bodily tissues/fluids) also may be at least partially formedfrom and/or coated with a biocompatible material such as, but notlimited to, platinum/iridium material or a platinum black-basedmaterial.

FIG. 4 is a diagram schematically representing a stimulation system 121as deployed within a patient, according to one example of the presentdisclosure. As illustrated in FIG. 4, in some examples system 121comprises an implantable pulse generator (IPG) 135, capable of beingsurgically positioned within a pectoral region of a patient 120, and astimulation lead 132 electrically coupled with the IPG 135. In someexamples, pulse generator 135 comprises at least some of substantiallythe same features and attributes as the pulse generator 104, aspreviously described in association with at least FIG. 2A and thevarious examples described throughout the present disclosure.

In some examples, at least some or all of the components of theimplantable system 121 are considered to be an implantable medicaldevice (IMD) 62 in FIG. 1.

As further shown in FIG. 4, the lead 132 includes a stimulation element145 (e.g. electrode portion, such a cuff electrode) and extends from theIPG 135 so that the stimulation element 145 is positioned in contactwith a desired nerve 133 to stimulate nerve 133 for restoring upperairway patency. In some examples, the desired nerve comprises ahypoglossal nerve. In some examples, stimulation element 145 comprisesat least some of substantially the same features and attributes as theelectrode 102, as previously described in association with at least FIG.2, and the various examples described throughout the present disclosure.

One implantable stimulation system in which lead 132 may be utilized,for example, is described in U.S. Pat. No. 6,572,543 to Christophersonet al., and which is incorporated herein by reference in its entirety.In one example, device 121 comprises at least one sensor portion 140(electrically coupled to the IPG 135 and extending from the IPG 135 vialead 137) positioned in the patient 120.

In some examples, sensor portion 140 provides one implementation of alead having a sensor electrode as described in association with at leastFIG. 2, and the various examples described throughout the presentdisclosure. As previously noted, in some such examples the attenuationarrangement is co-extensive with at least sensor portion 140, such asdefined for zone A in FIG. 2.

In some examples, sensor portion 140 senses respiratory effort, such asvia sensing respiratory pressure.

In some examples, the sensor portion 140 detects respiratory effortincluding respiratory patterns (e.g., inspiration, expiration,respiratory pause, etc.). In some examples, this respiratory informationis employed to trigger activation of stimulation element 145 tostimulate a target nerve 133. Accordingly, in some examples, the IPG 135receives sensor waveforms (e.g. one form of respiratory information)from the respiratory sensor portion 140, thereby enabling the IPG 135 todeliver electrical stimulation according to a therapeutic treatmentregimen in accordance with examples of the present disclosure. In someexamples, the respiratory information is used to apply the stimulationsynchronously with inspiration or synchronized relative to anotheraspect of the respiratory cycle. In some examples, the respiratorysensor portion 140 is powered by the IPG 135.

In some such examples, sensor portion 140, including electrode 102comprises an accelerometer.

In some examples, the sensor portion 140 comprises a pressure sensor. Inone example, the pressure sensor in this example detects pressure in thethorax of the patient. In other examples, the sensed pressure can be acombination of thoracic pressure and cardiac pressure (e.g., bloodflow). With this configuration, a controller associated with IPG 135 isconfigured to analyze this pressure sensing information to detect therespiratory patterns of the patient.

In some examples, the pressure sensor detects differential pressure.

In some other examples, the sensor portion represented via referencenumeral 140 comprises a bio-impedance sensor or an array ofbio-impedance sensors and can be located in regions other than thepectoral region. In one aspect, such an impedance sensor is configuredto sense a bio-impedance signal or pattern whereby the control unitevaluates respiratory patterns within the bio-impedance signal. Forbio-impedance sensing, in some examples electric current will beinjected through an electrode portion within the body and anelectrically conductive portion of a housing (i.e. case, can, etc.) ofthe IPG 135, with the voltage being sensed between two spaced apartstimulation electrode portions (such as stimulation element 145). Insome examples, the voltage is sensed between one of the stimulationelectrode portions and the electrically conductive portion of the caseof IPG 135 to compute the impedance.

In some examples, system 121 comprises other sensors (instead of sensorportion 140) or additional sensors (in addition to sensor portion 140)to obtain physiologic data associated with respiratory functions and/orother physiologic functions. For instance, as shown in FIG. 4, in someexamples system 121 may include various electrode portions 147, 148, 149distributed about the chest area for measuring a trans-thoracicbio-impedance signal, an electrocardiogram (ECG) signal, or otherrespiratory-associated signals, other cardiac signals, etc.

In some examples, the various electrode portions 147, 148, 149 or even asingle lead is used to measure trans-thoracic electrical bio-impedance.This measurement also can be used in combination with other parameters(e.g. cardiac, pulmonary, etc.) to determine respiratory effort and/orrelated health information.

In some examples, system 121 utilizes at least one accelerometer toobtain and provide sensing information regarding respiration and/orother conditions related to treating and/or evaluation sleep disorderedbreathing, such as obstructive sleep apnea.

In some such examples, the at least one accelerometer is incorporatedinto sensor portion 140 at the distal portion of sensing lead 137.

In some such examples, instead of having at least one accelerometer aspart of sensor portion 140, an at least one accelerometer is directlycoupled relative to the IPG 135. The accelerometer can be incorporatedinternally within a housing of the IPG 135 or can be affixed to anexternal portion of the IPG 135 in some fashion and electrically andcommunicatively coupled to circuitry within IPG 135.

In some examples, the system 121 can have at least one accelerometer asat least part of the distally-located sensor portion 140 and at leastone accelerometer coupled to the IPG 135 in the manner noted above.

As in the other examples, in any of these sensing arrangements, anattenuation arrangement is provided to attenuate MRI-energy relative tosuch sensors whether they are in a single or multiple differentlocations. The attenuation arrangement may comprises a single type ofattenuation or at least two types of attenuation. In some instances, onetype of attenuation is deployed at one location (e.g. sensor portion140) and a second different type of attenuation is deployed at a secondlocation (e.g. IPG 135), such as when sensor portion 140 extends fromlead 137. In some examples, both types of attenuation are deployed atboth locations.

In some examples, the sensing and stimulation system for treating sleepdisordered breathing (such as but not limited to obstructive sleepapnea) is a totally implantable system which provides therapeuticsolutions for patients diagnosed with obstructive sleep apnea. In otherexamples, one or more components of the system are not implanted in abody of the patient. A few non-limiting examples of such non-implantedcomponents include external sensors (respiration, impedance, etc.), anexternal processing unit, and/or an external power source. Of course, itis further understood that, in some examples, the implanted portion(s)of the system provides a communication pathway to enable transmission ofdata and/or controls signals both to and from the implanted portions ofthe system relative to the external portions of the system. Thecommunication pathway includes a radiofrequency (RF) telemetry link orother wireless communication protocols.

Whether partially implantable or totally implantable, in some examplesthe system is designed to stimulate an upper-airway-patency-relatednerve during some portion of the repeating respiratory cycle to therebyprevent obstructions or occlusions in the upper airway during sleep.

It will be understood that the implantable system 121 provides just oneexample of an IMD 62 for which an attenuation arrangement 74 attenuatesMRI energy, and that many other types of implantable systems fordifferent informational, diagnostic, and/or therapeutic purposes aresuitable for deployment with an associated attenuation arrangement 74 ofthe examples of the present disclosure.

FIG. 5A is a block diagram 200 schematically representing an attenuationarrangement 204 deployable relative to an MRI field 54, according to oneexample of the present disclosure. In some examples, attenuationarrangement 204 comprises one example implementation of the attenuationarrangement 74 in FIGS. 1-2.

As shown in FIG. 5A, MRI device 202 produces a field 54, in a mannersimilar to that shown in association with at least FIG. 1. Meanwhile,attenuation arrangement 204 is associated with implantable system 76(FIG. 2) to attenuate MRI-energy with respect to at least some portionsof the implantable system 76.

As shown in FIG. 5A, such an attenuation arrangement 204 may compriseone modality or several different modalities, which in turn may bedeployed separately or in combination. In some examples, such modalitiesinclude a first shield modality 210, a second shield modality 212, afilter modality 214, an antiphase modality 217, and a dissipationmodality 216. In some examples, the respective modalities may beinterrelated such as a shield modality blocking or absorbing MRI energyand facilitating dissipation of MRI energy. In another example, in someinstances the anti-phase modality may sometimes be considered to be anexpression of the dissipation modality 216, as described later invarious examples. In some examples, some of the respective modalitiesmay be independent of each other, either based on how they interact withthe MRI energy and/or because of their respective positions within thepatient's body. At least some specific example implementations of theseattenuation modalities are described below with respect to FIG. 5A andlater described in association with at least FIGS. 5B-33.

With regard to at least the dissipation modality 216, the exampleattenuation arrangements seek to dissipate the unwanted RF energy overthe largest surface area possible such that the dissipated RF energydensity may be minimized as much as possible.

In some examples, the anti-phase modality 217 and/or anti-phaseelement(s) 253 may address certain effects resulting from the presenceof the implantable medical device (e.g. at least lead 72) within a MRfield 54. For instance, at least some portion of the RF signals withinthe MR field may setup small e-fields along the lead 72 with at leastsome of the respective e-fields having a different magnitude and/ordifferent phases. However, via employing at least an anti-phase modality217 (e.g. via anti-phase elements 253) of an attenuation arrangementaccording to at least some examples of the present disclosure,anti-phase conductive structures may be incorporated into at least aportion of a shield structure and/or of other conductive attenuationarrangements. In some such examples, the anti-phase conductivestructures (e.g. 253 in FIGS. 5A-5D may employ inversions (and/ormanipulations) to create opposing phases of the e-fields, which in turncancel each other out, thereby substantially eliminating the RF energythat would otherwise impact the lead (and/or other components). In someexamples, such anti-phase modalities 217 and/or elements 253 (FIG. 5A)may be implemented according to at least the various examples laterdescribed in association with at least FIGS. 19A-19I and/or FIGS.20A-20F.

With this in mind, in some instances it may be described that from theperspective of the signal conductor (e.g. therapy conductor), the MRIsignal may be attenuated. In some instances, it may described that fromthe perspective of the attenuation arrangement, the MRI signal may bedissipated. In some examples of the attenuation arrangements, e-fieldshielding works by canceling the e-field by the shift of electronswithin the shield. In some such examples, such cancellation of e-fieldsmay be implemented via, and/or viewed as corresponding to, theanti-phase modality 217 (and/or anti-phase elements 253) in at leastFIG. 5A.

For high-frequency applications, the e-field can be actually absorbed bythe shield to some degree and so ought to be dissipated into the bodyover an appropriately sized surface. In some examples, the dissipationcan occur at a point (e.g. the electrode in an un-shielded lead) such asthe IPG or all along (or various points along) the entire shield ifcapacitively coupled to tissue.

With further reference to FIG. 5A, for illustrative clarity, diagram 200includes a dashed line 203 to represent an outer portion or outerboundary of at least some portions of implantable system 76 (FIG. 2),such that the first shield 210 is external to and spaced apart from theouter portion of some components of implantable system 76.

On the other hand, any one or several of the other modalities (212, 214,216, 217) are co-located directly with, or physically incorporatedwithin, components of the implantable system 76 (FIG. 2) as representedby their being on an opposite side of dashed line 203 relative to shield210.

In some examples, at least one instance of the first shield modality 210may be positioned externally and spaced apart from an implantable system76, as represented by distance D1.

As further shown in FIG. 5A, in some examples an array 241 ofattenuation elements 240-254 can be utilized to implement the variousattenuation modalities 210, 212, 214, 216, 217 according to one exampleof the present disclosure. As shown in FIG. 5A, in some examples thearray 241 includes a coil element 240, a mesh element 242, a flexibleprinted electronics (FPE) assembly 245, an inductive element 250, acapacitive element 252, an anti-phase element 253, or a combination 254of some of these elements.

In some examples at least some of these elements may be implemented invarious combinations (254) and/or may be implemented simultaneously(even if independently) via a flexible printed electronics (FPE)assembly 245. By doing so, such combinations may be implemented at areasonable cost and within a much smaller volume than at least somenon-FPE constructions. Stated differently, with at least some non-FPEconstructions, the cost and difficulty may increase substantially foreach additional element employed (in combination) due to at least thematerials, assembly cost, complexity of combining different elements,etc. In some instances, these challenges may make implementation ofmultiple modalities in a non-FPE construction to be impractical and costprohibitive. However, by employing a FPE assembly 245 according to atleast some examples of the present disclosure, a combination of elements(e.g. 240, 243, 250, 252, 253) of an attenuation arrangement 204 may beimplemented in a lead assembly (or other implantable medical device) ata reasonable cost and within a reasonable volume without unduedifficulty.

In some examples, as shown in FIG. 5A, a portion of implantable system76 comprises a flexible printed electronic (FPE) assembly 245. A numberof different detailed implementations of the FPE assembly 245 aredescribed and illustrated later throughout examples of the presentdisclosure. However, it can be generally noted that in at least someexamples, one or several of the modalities 210, 212, 214, 216, 217 ofattenuation arrangement 204 can be incorporated within, defined by,and/or cooperative with such flexible printed electronic assemblies 245.

As further shown in FIG. 5A, the various attenuation elements of array241 can be further specified with respect to how they relate to a FPEassembly 245. Accordingly, FIG. 5A depicts an array 281 of types ofstructures 280, 282, 284, and 290, which are identifiable anddistinguishable based on their relationship to aspects of a FPE assembly245.

As shown in FIG. 5A, in some examples array 281 includes a non-FPEassembly discrete structure 280. For instance, structure 280 maycorrespond to a discrete structure which is not formed as part of a FPEassembly 245 and which can be used to attenuate MRI-energy relative toat least a portion of an implantable system 76. In some examples, aconductive coil 240 or conductive mesh 242 can be formed as discreteelements, which are not part of a FPE assembly 245. In some instances,coil 240 and/or mesh 242 can define an external shield represented viafirst shield modality 210.

However, in some examples, an external shield (e.g. 210 in FIG. 5A) alsocan be at least partially defined by a FPE assembly 245, which isdistinct and separate from a FPE assembly 245 which forms a lead 72,electrode 102, etc.

As further shown in FIG. 5A, in some examples array 281 includes adedicated conductive structure 282 of a FPE assembly 245. In suchexamples, a FPE assembly 245 can be formed to include an attenuationelement which takes the form of a dedicated conductive structure in theFPE assembly 245. For instance, a FPE assembly 245 can be formed toinclude an inductive element 250 and/or capacitive element 252, whichare physically separate from, and independent of, other conductiveelements of the FPE assembly 245, such as stimulation signal conductiveelements and/or sensor signal conductive elements of the FPE assembly245.

In some examples, array 281 includes a dedicated discrete structure(e.g. component) 284. In some examples, such discrete components 284 areformed as an independent circuit element such as an application specificintegrated circuit (ASIC) or field-effect transistor (FET), which ismounted to the FPE assembly 245 (e.g. its substrate) and/or which are atleast partially defined by a FPE assembly 245. In some examples, theactive element 1125 in FIG. 18A corresponds to a dedicated discretecomponent 284.

In some examples, array 281 includes a non-dedicated conductivestructure (e.g. element) 290 of the FPE assembly. In other words, one ofthe various attenuation elements of array 241 is formed via a conductiveelement of the FPE assembly 245, which already has another function. Forinstance, certain conductive elements of the FPE assembly 245 mayalready define a signal conductive element for conveying signals forsensing (294) and/or stimulation (292) through a lead 72. In someexamples, such conductive elements may be arranged to provide inductivefunctionality (250) and/or capacitive functionality (252) even thoughsuch functionality is implemented via dedicated conductive componentsphysically separate signal conductive element(s). In other words, insuch examples, no additional conductive elements are dedicated solely todefining an inductive component and/or to defining a capacitivecomponent to act as an attenuation element. Rather the routing, size,and/or shape of the signal conductive elements (used to convey astimulation signal and/or a sensor signal) is configured to cause orenable inductive behavior and/or capacitive behavior. This behavior canattenuate MRI-energy according to a shield, filter, dissipation, and/oranti-phase modality (e.g. 212, 214, 216, 217).

FIG. 5B is a block diagram 300 schematically representing an attenuationarrangement in association with a lead assembly 302, according to oneexample of the present disclosure. As shown in FIG. 5B, lead assembly302 includes lead 72 and electrode 102. The lead 72 extends between aproximal end 105 and a distal end 103, with electrode 102 connected tothe distal end 103. It will be understood that, in some examples, atleast lead 72 is formed of a FPE assembly (245 in FIG. 5A) to implementan attenuation arrangement (204 in FIG. 5A). As shown in FIG. 5B, insome examples the attenuation arrangement comprises at least an array305 of inductive elements (L) arranged along lead 72, and therebyimplementing the inductive modality 250 in FIG. 5A. The inductiveelements L are spaced apart from each other by a distance D2 as theyextend along length L1 of lead 72. Distance D2 can be uniform betweenall the inductive elements L or can be different between some adjacentinductive elements in order to meet attenuation design goals.

In some examples, lead 72 is formed as an FPE assembly comprising alayered stack of signal conductive elements, insulative elements, shieldconductive elements, etc. (as later described in association with atleast FIGS. 6A-33). The inductive elements L can be positioned betweenadjacent layers, within a single layer, and/or extend from one layer toanother layer, etc. in order to arrange for a target inductance atcertain locations along lead 72 and/or to achieve an overall pattern ofinductance. In one aspect, the deployment of such inductive elements Lmay be considered a form of passive filtering of MRI energy.

In one aspect, such arrangements of inductive elements may reduce amagnitude of MRI energy that would otherwise tend to dissipate into thebody 72 as a result of the MRI magnetic field inducing an electric fieldin the patient's body. In particular, the particular arrangement ofinductive elements L along lead 72 can work to modify the transferfunction associated with such coupling (of the e-fields onto the lead72) resulting in a strategic reduction in a magnitude and/or alteredphase of the transfer function. In some examples, the transfer functionmay be at least partially defined based on a relationship between atangential electric field (E-tan) along the lead body (e.g. 72) and anRF energy dissipated at the lead electrodes 102 and/or heating at thelead electrodes 102.

In some examples, the deployment of inductive elements L corresponds tothe filter modality 214 in FIG. 5B with such inductive elements Lsometimes being referred to as a passive component. In some examples,placement of at least one inductive element L at the end of conductiveelements of lead 72 may help filter out MRI energy. In some examples,such placement of inductive element(s) L may combine with anelectrode-tissue capacitance and/or resistance to function as a low passfilter, thereby attenuating the MRI/RF energy. However, such a filtermay not attenuate a stimulation signal in lead 72 because the dominantfrequency components of the stimulation signal are at least one order ofmagnitude lower in frequency than the filter cutoff.

In some examples, a transistor such as field effect transistor (FET)also may produce similar results in filtering MRI energy.

FIG. 5C is a block diagram 320 schematically representing an attenuationarrangement in association with a lead assembly 322, according to oneexample of the present disclosure. In some examples, lead assembly 322comprises at least some of substantially the same features as leadassembly 302 in FIG. 5B, except having a more comprehensive attenuationarrangement 324. As shown in FIG. 5B, an array 323 of attenuationelements A are shown positioned along a length L1 of the lead 72 andalong a length L2 of the electrode 102.

As shown in FIG. 5C, the attenuation arrangement 324 may include onetype of element or a combination of several different types of elements,including inductive elements L, capacitive elements C, resistanceelements R, anti-phase elements (AP), shield elements (S) and/orcircuitry combined in an application specific integrated circuit (ASIC)or in a field effect transistor (FET).

It will be understood that, in some examples just some of theattenuation elements A are implemented and the spacing (D2) amongmultiple attenuation elements A may vary depending on the type andnumber of attenuation elements A. In some examples, the ASIC or FET maycorrespond to the active attenuation element as later described inassociation with FIG. 18A.

Moreover, in some examples, attenuation elements A are implementedsolely with respect to electrode 102 in zone B or attenuation elements Aare implemented solely with respect to lead 72.

In some examples, at least some shield elements (S) may be implementedalong at least the lead 72 with such shield element(s) being in contactwith surrounding bodily tissues and/or fluids. In some such examples, atleast some capacitive elements (C) may be implemented as part of lead 72and/or at part of a connecting block (e.g. header) of the IPG 104 withsuch capacitive elements (C) acting to present a short at MRI RFfrequencies between signal conductors (e.g. for sensing and/orstimulation) and the shielding element(s).

In some examples, at least some shield elements (S) may be implementedalong at least the lead 72 with such shield element(s) being in contactwith, or adjacent to, surrounding bodily tissues and/or fluids. In somesuch examples, at least some capacitive elements (C) may be implementedas part of lead 72 and/or at part of a connecting block (e.g. header) ofthe IPG 104 with such capacitive elements (C) acting to present a shortat MRI RF frequencies between the conductive case of the IPG 104 and theshielding element(s). In this way, the RF energy present on the shieldis dissipated by the case (e.g. external housing) of the IPG (e.g. 104in FIG. 2, 135 in FIG. 4, 760 in FIG. 11) while not affecting the normaltherapy function of the case of the IPG (e.g. 104, 135, 760), such aswhen using at least a portion of the case as a stimulation electrode(e.g. an anode).

In some examples, the effective length of the lead at the frequency ofthe MRI RF energy may be chosen as one-half the wavelength of the MRI RFenergy. In this way, the conductors form an anti-phase attenuationarrangement by virtue of the anti-resonant properties of the conductorat this wavelength. It should be noted that the wavelength of the MRI RFenergy in tissue is shorter than in air, as the permittivity of tissueis roughly two orders of magnitude larger than in air. Accordingly, thewavelength of the MRI RF energy in tissue is roughly one order ofmagnitude shorter than in air as the wavelength is proportional to theinverse of the square root of the permittivity.

FIG. 6A is a perspective view schematically representing an implantablelead assembly 400 including a FPE assembly 404 in a helically woundconfiguration, according to one example of the present disclosure. Asshown in FIG. 6A, lead assembly 400 includes an elongate support member403 about which FPE assembly 404 is helically wound. In some examples,FPE assembly 404 comprises at least some of substantially the samefeatures and attributes as a FPE assembly 245 in association with atleast FIGS. 5A-5C and/or as later described in association with at leastFIGS. 6B-33. In some examples, the elongate support member 403 comprisesa flexible, resilient member to provide strength, which can enhance flexresistance, handling, and/or durability. In some examples, the elongatesupport member 403 is non-conductive, e.g. electrically insulative.

However, prior to further describing the lead assembly 400, reference ismade to the perspective view of FIG. 6B which schematically representsthe FPE assembly 404 in its unwound (e.g. straight) configuration. Asshown in FIG. 6B, in some examples the FPE assembly 404 defines arelatively thin, elongate rectangular member which extends lengthwise(L3) between opposite ends 409A, 409B and has a width W1 betweenopposite sides 405A, 405B. FPE assembly 404 also has a top surface 408Aand an opposite bottom surface 408B, which define a thickness T1therebetween. In some examples, the width W1 is substantially greaterthan the thickness T1 and in some examples, the width W1 may be at leastone order of magnitude greater than the thickness T1. In some examples,the length L3 is substantially greater than the thickness T1 or widthW1, and in some examples, the length L3 may be at least one order ofmagnitude greater than the thickness T1 or width W1. In some examples,length L3 may be at least two orders of magnitude greater than thethickness T1 or width W1.

As further shown in FIG. 6B, a length of the FPE assembly 404 extends ina first orientation A parallel to a longitudinal axis of the FPEassembly 404, while a width of the FPE assembly 404 extends in a secondorientation B transverse to orientation A.

Moreover, it will be understood that the length L3 of the FPE assembly404 prior to being helically wound as in the example of FIG. 6A, will besubstantially greater than the length L1 of the lead assembly 400. Insome examples, the length L3 may be at least one order of magnitudegreater than the length L1.

Meanwhile, the FPE assembly 404 comprises an array of signal conductiveelements such that, via FPE assembly 404, lead assembly 400 can conveystimulation signals and/or sensor signals along a length (L1) of thelead assembly 400 such as from an IPG 104 to an electrode 102.

It will be understood that FPE assembly 404 can have a wide variety ofconfigurations of signal conductive elements and non-signal conductiveelements, with at least some examples of such configurations describedthroughout the present disclosure.

In some examples, a FPE assembly 404 may comprise electronic structuresformed via printing the respective insulative and conductive elements aslayers with at least some of the insulative material corresponding to aflexible substrate generally supporting and/or forming the entireassembly 404. While the flexible substrate may allow some bending andflexing, it exhibits enough resilience to withstand repeated flexing andbending while maintaining its structural integrity and maintaining theadhesion of conductive elements printed relative to the substrate.Moreover, by employing the substrate (in a FPE assembly 404) in a coiledconfiguration as shown in at least FIG. 6A, the coiled configuration mayenhance protecting the structural integrity of the substrate and FPEassembly 404 during flexing, bending, stretching, etc.

In some examples, the substrate can be formed from a liquid crystalpolymer (LCP) material, a polyimide material, a polyether ether ketone(PEEK) material, and other dielectric polymers.

In some examples, the flexible substrate may enable complex geometriesthat can be folded, stacked, molded over, and curved around the leadbodies. This capability allows many configurations of printed componentsand elements, thereby enabling close control over target parameters indesign of a lead assembly to meet MRI energy attenuation goals and tokeep lead manufacturing repeatable and low cost.

In forming this assembly 404, whole or partial layers are printed of thevarious materials to define a monolithic structure, which is inclusiveof the targeted physical and electrical functionality to performelectronic functions, such as conveying signals and/or other morecomplex electronic functions.

With this in mind, further reference is made to the perspective view inFIG. 6A of lead assembly 400. In the helically wound configuration, theFPE assembly 404 defines a plurality of windings 406, with each windinghaving a pair of opposite outer edges 405A, 405B. A gap G1 is formedbetween adjacent windings 406.

The elongate support member 403 comprises a generally cylindricalmember. In some examples, support member 403 defines a lumen 409extending throughout a length of support member 403. Via thisarrangement, the elongate support member 403 has greater flexibility andexhibits the same general functionality but while using less material.In some examples, the elongate support member 403 defines a core of thelead assembly 400. In some examples, the elongate support member 403 ismade from a material, such as silicone, polyurethane, etc. Via thisarrangement, the elongate support member 403 helps to prevent kinking ofthe lead assembly 402, provides increased flex resistance, and/orprovides a feel to the operator that more closely resembles atraditional lead structure.

It will be understood that the terms insulative and insulator may beused interchangeably throughout the present disclosure, and generallyrefer to materials which are electrically non-conductive. In thisregard, in some instances such insulative material may sometimes bereferred to as a dielectric material or dielectric coating.

In some examples, the helically wound configuration of the FPE assembly404, in combination with the elongate support member 403 provides forpushability, steerability, torquability, and sufficient flexibility topromote advancement and maneuvering the lead assembly 400 within a bodyportion. In some examples, the gap G1 is selected to provide enoughflexibility to enable adequate maneuverability yet provide enoughresilience (e.g. firmness or rigidity) to enable pushing and steering ofthe lead assembly 400.

FIG. 6C is a perspective view of a lead assembly 420, according to oneexample of the present disclosure. In some examples, lead assembly 420comprises at least substantially the same features and attributes as thelead assembly 400, except for the general arrangement omitting theelongate support member 403 such that the FPE assembly 404 comprises thesole component of lead assembly 420.

It will be further understood that in some examples, when FPE assembly404 comprises the sole component of lead assembly 420, the FPE assembly404 may have a straight configuration (FIG. 6B) or may have athree-dimensional shape configuration other than being helically wound,such as undulating, sinusoidal, folded, etc.

FIG. 7A is a diagram including a sectional view schematicallyrepresenting a FPE assembly 460, according to one example of the presentdisclosure, which is just one example implementation of FPE assembly 404in FIG. 6A-6C and 245 in FIG. 5A. As shown in FIG. 7A, in general termsFPE assembly 460 includes a conductive element 514A and a substrate 508relative to which the conductive element 514A can be printed. Via thisarrangement, the conductive element 514A can convey a signal along thelength of the FPE assembly (e.g. 404 in FIG. 6A), thereby conveying thesignal along the length L1 of the lead assembly (400 in FIG. 6A).

In some examples, the substrate 508 provides a foundation on which asignal conductive element 514A can be printed and relative to whichother elements can be printed. In some examples, the substrate 508 andat least some other insulative materials of the various FPE assemblies(as described throughout examples of the present disclosure) comprise atleast some of substantially the same features as the substrate describedin association with at least FIG. 6A-6C.

It will be understood that, in some examples, the same material fromwhich the substrate is formed also can be used to form an outerinsulative layer of a FPE assembly, to insulate an entire lead assembly,etc.

As further described in association with at least FIGS. 7B-7E, 10-12,15-16, 18D, in some instances at least a portion of the substrate 508may be referred to as a base insulator 510.

FIG. 7B is a diagram including a sectional view schematicallyrepresenting a FPE assembly 470, according to one example of the presentdisclosure, which is just one example implementation of FPE assembly 404in FIG. 6A-6C and 245 in FIG. 5A. The FPE assembly 47 comprises at leastsome of substantially the same features and attributes as the FPEassembly 460 (FIG. 7A), except further comprising a first insulator 518Asuch that signal conductive element 514A becomes common to, andsandwiched between, base insulator 510 and the first insulator 518A.

It will be understood that in some examples the signal conductiveelement 514A may not be entirely conductive. In other words, the signalconductive element 514A may comprise a layer of non-conductive material(e.g. a substrate) which carries or supports at least one conductivetrace which serves as the signal conductor. In some examples, a printedcircuitry construction may be employed in which the base insulator 510may serve as the substrate onto which the conductive traces are printedsuch that conductive element 514A in FIG. 7B may be considered not to bea physically separate element from base insulator 510. In some examples,the at least one conductive trace may comprise several independentconductive traces which each carry different electric signals.

In some examples, the arrangement later described in association withFIG. 13 and/or FIG. 14 may comprise one example implementation of theconductive element 514A in FIG. 7B.

FIG. 7C is a diagram including a sectional view schematicallyrepresenting a FPE assembly 475, according to one example of the presentdisclosure, which is just one example implementation of FPE assembly 404in FIG. 6A-6C and 245 in FIG. 5A. The FPE assembly 475 comprises atleast some of substantially the same features and attributes as the FPEassembly 470 (FIG. 7B), except further comprising a second signalconductive element 514B, such that base insulator 510 becomes common to,and sandwiched between, the pair of signal conductive elements 514A,514B. Meanwhile, as further shown in FIG. 7C, a pair of insulators 518A,518B are external to the signal conductive elements 514A, 514B.

FIG. 7D is a diagram 500 including a sectional view schematicallyrepresenting a FPE assembly 480, according to one example of the presentdisclosure, which is just one example implementation of FPE assembly 404in FIG. 6A-6C and 245 in FIG. 5A. The FPE assembly 480 comprises atleast some of substantially the same features and attributes as the FPEassembly 475 (FIG. 7C), except further comprising a first shieldconductive element 517A as shown in FIG. 7D.

In some examples, the first shield conductive element 517A comprises thesole shield conductive element of the flexible printed electronicassembly. As shown in FIG. 7D, the first shield conductive element 517Ais located on an upper portion 481A of the FPE assembly 480 to belocated closer to an upper outer surface 408A of the FPE assembly 480.Via this arrangement, the flexible printed electronic assembly 480 doesnot include a comparable shield conductive element on lower portion 481Bat a position interior of the upper outer surface 408A of FPE assembly480.

In some examples, the first shield conductive element 517A may be inindirect contact with bodily tissues and/or body fluids. In someexamples, this indirect contact may be achieved via placing small holes(e.g. pin size) in the third insulator 520A to thereby enhance couplingof the RF energy to the first shield conductive element 517A.

In some examples, the arrangement of FIG. 7D is deployed in at leastsome examples in which the FPE assembly 480 is in a helically woundconfiguration with the outer surface 480A defining the outermost surfaceof the FPE assembly 480. In this way, shielding is provided for theinteriorly located signal conductive elements 514A, 514B, as describedand/or illustrated in association with at least FIGS. 6A, 6C, 19-21, 23,and 25.

In some examples, the example arrangement of FIG. 7D is deployed in atleast some examples in which the FPE assembly 480 is in a straightconfiguration (e.g. not helically wound) with the outer surface 480Adefining the outermost surface of the FPE assembly 480 to shield theinteriorly located signal conductive elements 514A, 514B.

In some examples, in which a FPE assembly such as FPE assembly 480 actssolely as a shield structure (e.g. not to convey a signal), then asimilar arrangement of a single shield conductive element can beimplemented. In some such examples, the FPE assembly can adopt thearrangement of either FIG. 7A or FIG. 7B in which the conductive element514A is implemented as a shield conductive element and not to convey asignal.

As further shown in FIG. 7D, in some examples of the FPE assembly 480, afirst insulator 518A has a thickness T3, which is substantially greater(e.g. 2×, 3×) a thickness T2 of a third insulator 520A in contact withtissue 505. Via this arrangement, in some examples, the thickness T2 ofthe third insulator 520A is relatively thin (e.g. minimized) to increasecapacitance between the first shield conductive element 517A and thebody tissue 505, which thereby facilitate dissipation of energy from thefirst shield conductive element 517A upon its absorption of MRI RFenergy. Meanwhile, in one aspect, the relatively larger thickness T3 ofthe first insulator 518A may decrease capacitive coupling from the firstshield conductive element 517A to adjacent signal conductors, such asbut not limited to at least signal conductive element 514A.

In some examples, a total surface area of the first shield conductiveelement 517A is formed as a contiguous sheet or layer of conductivematerial (e.g. not a mesh but a solid plane of conductive material) toincrease capacitance between the first shield conductive element 517Aand the body tissue 505.

FIG. 7E is a diagram 500 including a sectional view schematicallyrepresenting a FPE assembly 502, according to one example of the presentdisclosure, which is just one example implementation of FPE assembly 404in FIG. 6A-6C and 245 in FIG. 5A. As shown in FIG. 7E, in general termsFPE assembly 502 includes an array of elements (510, 514A, 514B, 518A,518B, 517A, 517B, 520A, 520B) arranged as layers in a vertically stackedrelationship.

The FPE assembly 502 comprises at least some of substantially the samefeatures and attributes as the FPE assembly 480 (FIG. 7D), exceptfurther comprising a second shield conductive element 517A and a fourthinsulator 520B as shown in FIG. 7E. The pair of shield conductiveelements 517A, 518A are external to the first and second insulators518A, 518B. The third and fourth insulators 520A, 520B are external tothe respective shield conductive elements 517A, 517B and also define anoutermost layer of the FPE assembly 502.

Meanwhile, the pair of shield conductive elements 517A, 517B at leastpartially surround the signal conductive elements 514A, 514B toattenuate MRI-energy relative to at least the signal conductive elements514A, 514B. The shield conductive elements 517A, 517B correspond to atleast the shield modality 212 in FIG. 5A.

In some examples, a FPE assembly 502 having a respective shieldconductive element 517A. 517B on opposite sides of the signal conductiveelements 514A, 514B can be used in one of the examples in which the FPEassembly 502 is deployed in a generally straight configuration (e.g. anon-helically wound configuration), such as later described inassociation with at least FIGS. 22-24.

In some examples, the shield conductive elements 517A, 517B comprise amesh structure. However, in some examples, the shield conductiveelements 517A, 517B can comprise a solid sheet of conductive material.In some examples, the solid sheet comprises a contiguous layer lackingholes, such as an uninterrupted plane of material.

In one aspect, to the extent that the entire FPE assembly 502 may bearranged in a helically wound configuration as in the lead assembly 400of FIG. 6A, then the shield conductive elements 514A, 514B also can beunderstood to define a coil (240 in FIG. 4). Accordingly, in someexamples, the gap G1 between windings 406 in FIG. 6A is at least oneorder of magnitude less than a wavelength of MRI field signals (withinthe body).

In some examples, the FPE assembly 502 is configured to provide RFshielding by providing a path for RF-induced e-fields (MRI-energy) to bedissipated. In particular, in one aspect the shield conductive elements517A are provided beneath a third insulator 520A having a relativelysmall thickness (T4) such that the electrical energy absorbed by theshield conductive element 517A is dissipated via a passive high-passfilter (capacitor) created between the shield conductive element 517Aand the surrounding tissue 505.

In one aspect, by implementing this shielding arrangement of a shieldconductive element 517A covered by a thin insulator 520A as part of aFPE assembly, precise control over the parameters of the shield designcan be achieved. In particular, in some examples insulator 520A wouldhave a thickness (T4) on the order of less than 0.1 millimeters with atolerance of less than 0.1 millimeters.

Accordingly, by constructing the shield conductive element 517A andcovering insulator 520A via printing those elements as part of the FPEassembly, one can tightly control the thickness (T4, T5) of theinsulator 520A, 520B. By doing so, the relatively thin layer ofinsulative material between the shield and the patient's tissue 505 mayensure that high frequency energy is effectively dissipated by theshield into the body by virtue of the capacitance formed between thetissue and insulators 520A, 520B, which presents a low impedance to highfrequency RF energy. In this way, the shield conductive elements 518A,518B exhibit both a shield (e.g. blocking) modality 212 and adissipation modality 216 (FIG. 5A).

In some examples, the shield conductive element 517A is formed as amesh, such as a pattern of conductive elements defining a network ofapertures or spacings at least one order of magnitude less than thewavelength of the targeted RF energy (within the body). In someexamples, the RF energy can be 64 MHz for a 1.5 T scanner or can be 128MHz for 3 T scanner. This arrangement may prevent the shield conductiveelement 517A from acting an RF-energy attracting antenna. In someexamples, the shield conductive element 517A can take the form of a meshas shown in FIG. 17A or as in FIG. 8A.

In some examples, the base insulator 510 may be considered a substrateon which the signal conductive elements 514A, 514B are printed andrelative to which other elements are printed. In some examples, the baseinsulator and at least some other insulative materials of FPE assembly502 comprise at least some of substantially the same features as thesubstrate described in association with at least FIG. 6A-6C.

FIG. 8A is a top view schematically a portion of a FPE assembly 530including a conductive element on an insulator, according to one exampleof the present disclosure. In some examples, this arrangement may bedeployed as one of the shield conductive elements of the 517A, 517B oras one of the signal conductive elements 514A, 514B of the FPE assembly502 in FIG. 7E. When used as a signal conductive element, this structuremay provide improved filtering relative to a linear conductor by virtueof the increased inductance of the conductor.

As shown in the diagram 531 of FIG. 8A, a portion of a FPE assembly 530includes an insulator element (e.g. layer) 535 on which a conductiveelement 536 has been printed in a pattern 540. In such examples, theinsulator layer 535 in FIG. 8A may correspond to one of the insulators(518A, 518B) in FIG. 7 and the conductive element 536 defining thepattern 540 in FIG. 8A may correspond to a respective one of the shieldconductive elements (517A, 517B) in at least FIG. 7E.

As shown in FIG. 8A-8B, in some examples the pattern 540 comprises anarray 542 of struts 543, which are spaced apart from each other andextend general parallel to each other in an orientation B (FIG. 6B),which is transverse to a longitudinal axis (e.g. orientation A in FIG.6B) of the FPE assembly. The pattern 540 also comprises an array ofcross members 544 which are aligned generally transverse to the struts543, with each cross member 544 connecting an adjacent pair of struts543. In one aspect, in some examples, via this pattern 540, the variousstruts 543 and cross members 544 define a single connected conductiveelement which can function as a mesh 242 (FIG. 4) and shield conductiveelement (517A or 517B) or signal conductive element 514A, 514B.Accordingly, in some examples, a spacing G2 is at least one order ofmagnitude less than such wavelengths of the MRI field signals (withinthe body). In some examples, such spacing G2 is at least two orders ofmagnitude less than such wavelengths of the MRI field signals (withinthe body).

Via this arrangement, a shield modality 212 or a filter modality 214 ofan attenuation arrangement 204 in FIG. 5A is implemented via a mesh 242type of attenuation element. An FPE assembly 245 (FIG. 5A) withconductive element 536 in FIG. 8A is one implementation of a dedicatedconductive structure 282 (of an FPEA) as represented in FIG. 5A.

In one aspect, the pattern 540 in FIG. 8A can be viewed as providing aserpentine looping configuration which can increase inductance of thesignal conductive element 514A, 514B, thereby enhancing attenuation ofthe MRI-energy field signals. In some examples, a width W2 of theconductive struts 543 and/or a width of the cross members 544 can bereduced to further increase the inductance, and thereby further enhancesuch attenuation.

In some examples, as shown in the perspective view of FIG. 8B, theprinted pattern 540 also comprises a plurality of printed vias 549extending (vertically) on, and partially defining, the sides 405A, 405Bof the FPE assembly 530. The vias 549 further surround the signalconductive elements 514A, 514B within a shielding structure to enhanceattenuate MRI-energy relative to the signal conductive elements 514A,514B.

As will apparent from additional examples, additional insulativestructures, such as but not limited to, insulators 520A, 520B in FPEassembly 502 in at least FIG. 7E can be used to control capacitivecoupling of the shield pattern 540 relative to surrounding tissue 505.

FIG. 9 is a diagram 590 including a perspective view schematicallyrepresenting a portion 591 of a FPE assembly including a conductiveelement 592 forming a three-dimensional (3D) coil structure 593 relativeto an insulator portion 595, according to one example of the presentdisclosure.

In some examples, this arrangement may be deployed to implement at leastthe shield conductive elements 517A, 517B of the FPE assembly 502 inFIG. 7. In some examples, this arrangement may be deployed to implementother conductive elements, such as but not limited to a signalconductive element of an FPE assembly in some examples of the presentdisclosure.

As shown in FIG. 9, the insulator portion 595 includes at least a topsurface 597 and a bottom surface 598, and in some examples, the topsurface 597 corresponds to an exposed insulator layer 518A in FIG. 7 andthe bottom surface 598 corresponds to an exposed insulator layer 581B inFIG. 7. Meanwhile, a pattern 605 of conductive material is arranged inthe 3D coil structure 593 relative to the insulator portion 595.

In some examples, as shown in FIG. 9 the 3D coil structure 593 includesa conductive strut 610 on top surface 597, and conductive strut 612(shown in dashed lines) is on bottom surface 598. In some examples, eachrespective strut 610, 612 includes a first portion 611 with both firstportions 611 extending general parallel to each other in the secondorientation B, which is transverse to the first orientation A whichextends parallel to a longitudinal axis of the FPE assembly (asrepresented by directional arrow A).

In some examples, each strut 610, 612 may correspond to a layer such asa shield conductive element 517A, 517B, respectively or such as signalconductive element 514A, 514B, respectively.

Each strut 610, 612 also includes a second portion 613 extending in thefirst orientation (A) generally transverse to main portion 611, withvertically extending conductive struts 620 connecting the secondportions 613 of the respective top and bottom conductive struts 610,612. As shown in FIG. 9, together these struts 610, 612, 620 form the 3Dcoil structure 593, which can act as a filter, such as filter modality214 of the attenuation arrangement 204 in FIG. 4. In some examples, thecoil structure 593 may serve to increase the inductance of theconductor, thereby increasing the impedance of the conductor at highfrequencies, thereby forming a filter for RF energy. The verticallyextending struts 620 may sometimes be referred to as vias.

In some examples, a spacing G3 is at least one order of magnitude (or atleast two orders of magnitude) less than a wavelength of the MRI-energyfield signals (within the body).

In some examples, the conductive structures as described and illustratedin association with FIGS. 8A, 8B, 9 may further embody an arrangement ofmultiple conductive elements carrying independent signals in a mannersubstantially similar to the arrangement as later described inassociation with FIG. 13. In some examples, the conductive structures asdescribed and illustrated in association with FIGS. 8A, 8B, 9 mayfurther embody an arrangement of multiple conductive elements carryingthe same signal in a manner substantially similar to the arrangement aslater described in association with FIG. 14.

FIG. 10 is a diagram including a sectional view schematicallyrepresenting a FPE assembly 700, according to one example of the presentdisclosure. In some examples, FPE assembly 700 comprises at least someof substantially the same features as FPE assembly 502 of FIG. 7E,except for additionally comprising additional layers of shieldconductive elements 718A, 718B and an additional layer of outerinsulators (720A, 720B).

In particular, layered externally to third and fourth insulators 520A,520B, the FPE assembly 700 includes a third shield conductive elementand a fourth shield conductive element 718A, 718B, with fifth and sixthinsulators 720A, 720B being provided as outer insulative covers.

In some examples, the third and fourth shield conductive elements 718A,718B comprise at least substantially the same feature and attributes asthe first and second shield conductive elements 517A, 517B (FIG. 7E). Insome examples, the third and fourth shield conductive elements 718A,718B comprise at least some features and attributes different than thefirst and second shield conductive elements 517A, 517B. In someexamples, such differences may include having a different type of mesh,being a solid sheet, or one pair of shield elements (inner or outer)being formed as a three-dimensional coil structure as in FIG. 9 and theother pair shield element being formed as mesh or some other shieldingstructure.

Via the arrangement in FIG. 10, a double layer of shielding is providedto further enhance attenuation of MRI energy such as via enhancingcapacitive coupling to the surrounding tissue. In one aspect, thecapacitance value is controlled by selecting a size or area of theshield conductive elements 517A, 718A, and 517B, 718B, their shape, anda separation between the layers, such as between the first and thirdshield conductive elements 517A, 718A and between the second and fourthshield conductive elements 517B, 718B. The separation is controlled viaselecting a thickness (T4, T5) of the respective third and fourthinsulators 520A, 520B.

In some examples, the shielding arrangement in FIG. 10 corresponds to atleast the shield modality 212 and/or dissipation modality 216 and/orantiphase modality 217 in the attenuation arrangement of FIG. 5A.

FIG. 11 is diagram 750 including a sectional view schematicallyrepresenting a FPE assembly 502 and a block diagram of an implantablepulse generator (IPG) 760 to which the FPE assembly of an implantablelead assembly is coupled, according to one example of the presentdisclosure. In some examples, the FPE assembly 502 comprises at leastsome of substantially the same features as FPE assembly 502 in FIG. 9.In some examples, the IPG 760 comprises at least some of substantiallythe same features and attributes as IPG 104 in FIG. 2.

As shown in FIG. 11, in some examples the first shield conductiveelement 517A and the second shield conductive element 517B arephysically and electrically coupled via elements 752A, 752B to anexternal conductive surface 764 of a housing 762 of the IPG 760. Viathis arrangement, the MRI-energy may be dissipated over a larger surfacearea within the body than attempting dissipation solely at an electrodeor at the lead. In other words, the housing 762 of the IPG 760 may actas an energy sink for the MR energy collected by the shield (e.g. shieldconductive elements 517A, 517B) of the FPE assembly (or even externalshield). The extent to which the IPG housing 762 may act as an energysink may depend on the length of the associated lead assembly, magnitudeof MR energy, surface area of the IPG housing 762, and type of tissuessurrounding the IPG housing 762.

Accordingly, in one respect, the shield conductive elements correspondto the shield modality 212 of the attenuation arrangement 204 in FIG. 4,while their coupling to the IPG corresponds to the dissipation modality216 of the attenuation arrangement 204 in FIG. 4.

In some examples, the two conductive elements 752A, 752B may be coupledtogether before being coupled to the housing 762, such as via a commonnode or connector. Via this arrangement, coupling to the housing 764 ofthe IPG 760 may be simplified.

In some examples, the IPG housing 762 and/or its header 765 comprises adedicated port 768 to receive a connector from the conductive elements752A, 752B to ensure a robust mechanical and electrical coupling of theconductive elements 752A, 752B relative to IPG 760 and thereforerelative to the conductive surface 764.

As noted in association with some other examples throughout the presentdisclosure, it will be understood that the FPE assembly 502 may in someexamples extend an entire length (L1 in FIG. 2) of a lead 72 such thatthe length of elements 752A, 752B is rather small. However, in someexamples, the FPE assembly 502 may extend just along a portion of thelead 72 or just along a length of the electrode 102 (FIG. 2) such thatthe respective conductive elements 752A, 752B may have a relativelylarge length.

FIG. 12 is a sectional view schematically representing a FPE assembly850 (of an implantable medical device IMD 62 in FIG. 1) including aradiofrequency (RF) antenna, according to one example of the presentdisclosure. In some examples, FPE assembly 850 comprises at least someof substantially the same features and attributes as FPE assembly 700 inFIG. 10, except for further comprising an RF antenna 866. The RF antenna866 may be used for communicating with other implanted devices and/or tocommunicate with devices external to the patient's body.

However, in order to maintain sufficient attenuation of MRI-energyrelative to the signal conductive elements 514A, 514B, FPE assembly 850includes additional insulative structures.

Accordingly, in comparison to FPE assembly 700 shown in FIG. 10, the FPEassembly 850 in FIG. 12 includes the same third shield conductiveelement 718A and fifth insulator 720A but omits fourth shield conductiveelement 718B and sixth insulator 720B. However, as shown in FIG. 12, theRF antenna 866 is printed on top of the fifth insulator 720A external tothe third shield conductive element 718A. In addition, a sixth insulator862 and a seventh insulator 864 further surround the RF antenna 866. Itwill be understood from FIG. 12 that, in at least some examples, thesixth insulator 862 and RF antenna 866 represent an arrangement in whichthe conductive portion of the RF antenna 866 is electrically isolatedfrom surrounding body tissues and/or fluid, and that, in at least someexamples, the sixth insulator 862 may not necessarily represent aseparate structure from RF antenna 866 and/or from seventh insulator 864and/or fifth insulator 720A.

Via this arrangement, the FPE assembly 850 is asymmetrical regarding theamount of shielding (per shielding modality 212) on a first portion 870Aof FPE assembly 850 than on second portion 870B. In particular the firstportion 870A has substantially more shielding and substantially moreinsulative elements than second portion 870B. In one aspect, thisarrangement may help to compensate for the increased coupling for MRIsignals that would otherwise be expected due to the presence of RFantenna 866. Accordingly, first portion 870A enhances the attenuationarrangement relative to the signal conductive elements 514A, 514B. Inaddition, in some examples, the filtering modality (e.g. 214 in FIGS.5A-5D) may be employed to prevent or minimize interference from MRI RFfrequencies.

FIG. 13 is a top view schematically representing a portion 880 of a FPEassembly including at least a layer of separate signal conductiveelements 884, 886, 888, according to one example of the presentdisclosure. In particular, as shown in FIG. 13, three distinct signalconductive elements 884, 886, 888 are printed onto an insulator 882 in agenerally coplanar arrangement. In some examples, the insulator 882corresponds to a base insulator 510 in one of the previously describedexamples while the three signal conductive elements 884, 886, and 888may correspond to one or both of the shield conductive elements 517A,517B.

Each respective signal conductive element 884, 886, 888 carries aseparate signal independent of the other respective signal conductiveelements 884, 886, 888.

FIG. 14 is a top view schematically representing a portion 890 of a FPEassembly including at least a layer of separate signal conductiveelements 892A, 892B, 892C, according to one example of the presentdisclosure. As shown in FIG. 14, portion 890 of the FPE assemblycomprises substantially the same features and attributes as the portion880 of the FPE assembly in FIG. 13, except that the three differentsignal conductive elements 892A, 892B, 892C carry the same signal. Viathis arrangement, the same signal is carried via parallel routes tobuild redundancy into the FPE assembly. Accordingly, in the event thatone of the signal conductive elements 892A, 892B, 892C may becomeinoperable, then two other signal conductive elements of the arrayalready would be carrying the signal.

In some examples, the arrangement in FIG. 13 and/or FIG. 14 may compriseat least some of substantially the same features and attributes aspreviously described for signal conductive element 514A in associationwith at least FIG. 7B.

FIG. 15 is a sectional view schematically representing a FPE assembly1000 including exposed shield conductive elements 517A, 517B, accordingto one example of the present disclosure. In some examples, FPE assembly1000 comprises at least some of substantially the same features andattributes as FPE assembly 502 in FIG. 7E, except omitting the outermostinsulators 520A, 520B such that the shield conductive elements 517A,517B become exposed. In one respect, via this arrangement a greaterexposure of the shield conductive elements 517A, 518B may enhance theirability to attenuate the MRI energy because those elements are directlycoupled relative to the surround body tissue, thereby establishing alarger surface area over which the MRI-energy may be shielded and/ordissipated. Accordingly, via this arrangement, continual electricalcontact is maintained between the body tissue and the shield conductiveelements.

FIG. 16 is a sectional view schematically representing a FPE assembly1030 including at least partially exposed vias 1037B coupled to a shieldconductive element 517A, according to one example of the presentdisclosure. In some examples, FPE assembly 1030 comprises at least someof substantially the same features and attributes as FPE assembly 502 inFIG. 7E, except for modifying the upper outermost insulator (e.g. thirdinsulator 520A) to form third insulator 1032 to accommodate vias 1037A,1037B. In particular, in some examples the vias 1037A, 1037B are printedonto portions of the first shield conductive element and extend throughapertures 1033A, 1033B of the outermost insulator 520A such that a topsurface of the vias 1037A, 1037B become directly exposed to an externalenvironment for direct coupling to surrounding body tissue.

Via this arrangement, an insulator still generally covers the shieldconductive element 517A but the vias provide paths by which the shieldconductive element 517A can be coupled to the surrounding body tissue toincrease the overall surface area over which the MRI-energy isdissipated. At the same time, the shield conductive element 517A (andshield conductive element 517B) attenuates the MRI energy.

In some examples, such as but not limited to the lead assembly 1300 ofFIG. 22B, even when some conductive elements are exposed on an outersurface of the FPE assembly 1000 (FIG. 15) 1030 (FIG. 16), an outertubular insulator is provided. In such arrangements, when the insulator1032 (FIG. 16) is sufficiently thin, the arrangement can enhance thecapacitive coupling of the shield conductive element 517A relative tothe surrounding tissue, which in turn enhances dissipation of energy atshield conductive element 517A upon receiving MRI-energy, as previouslydescribed in association with at least FIG. 7.

With regard to the examples of FIG. 15 or FIG. 16, it will be understoodthat passive components, such as inductors or capacitors may beimplemented as part of or connected to the shield conductive element517A (FIG. 15) and/or the vias 1033A, 1033B (FIG. 16). In one aspect,such arrangements may further enhance capacitive coupling relative tothe surrounding body tissue, and thereby enhance energy dissipation fromthe shield conductive elements into the surrounding body tissue.

With regard to the example arrangements in FIG. 15 or FIG. 16, it willbe understood that in some examples the second shield conductive element517B (and outer insulator 520B in FIG. 16) can be omitted such thatshielding functionality is provided on just one side of the respectiveFPE assemblies 1000, 1030. The asymmetric shielding arrangement in FIG.7D provides one such example.

FIG. 17A is a top view schematically representing a portion of a FPEassembly 1050, according to one example of the present disclosure. Insome examples, as shown in FIG. 17A the FPE assembly 1050 includes aninsulator 1052 on which is printed a conductive element 1053 in a meshpattern 1055. In some examples, the spacing S1 between adjacent struts1054 of the mesh pattern is at least one order of magnitude less thanthe wavelength of the MRI-energy field signals (within the body), and insome examples, the spacing S1 is at least two orders of magnitude lessthan such wavelengths. In one aspect, this arrangement corresponds to atleast the shield modality 212 and/or shield modality 210 in theattenuation arrangement 204 of FIG. 2. In some examples, via its meshpattern 1055, the conductive element 1054 provides one exampleimplementation of at least a respective one of the shield conductiveelements 517A, 517B (or 718A in FIG. 12). It will be understood thatFIG. 17A provides generous spacing between adjacent struts 1054 forillustrative purposes, but that an actual mesh would have an appearanceof much closer spacing between adjacent struts 1054.

In some examples, the arrangement of the conductive element 1054 can beused as a signal conductive element, such as signal conductive element514A and/or 514B (FIG. 7), instead of being used as shield conductiveelement (e.g. 517A, 517B). In such arrangements, the mesh pattern 1055is defined by a single conductive element, wherein the mesh pattern 1055provides a form of redundancy via the multiple pathways by which asignal may travel along the multiple different conductive struts 1054 ofthe mesh pattern 1055. Accordingly, this arrangement can mitigatefatigue of the conductive elements which may potentially arise due toflexing of the FPE assembly within the body, which may occur duringinitial implantation or during long term use.

FIG. 17B is a top view schematically representing a conductive element1062 of a FPE assembly 1060, according to one example of the presentdisclosure. In some examples, the conductive element 1062 is arranged ina generally curved shape (e.g. sinusoidal) to minimize stressconcentrations, which in turn may minimize crack propagation due toflexing of the lead assembly in the patient's body. In this way, theconfiguration of the conductive element potentially maximizes longevityof the conductive elements. In one aspect, the curved shape of theconductive element also can contribute to enhanced general flexibilityof the FPE assembly 1060, as compared to other examples of an FPEassembly, which may (or may not) have arrangements of conductiveelements exhibiting less flexibility. In some examples, when used as asignal conductive element, this structure may provide enhanced filteringrelative to a linear conductor by virtue of the increased RF impedanceof the conductor.

In some examples, such curved shapes may be implemented in a meshconfiguration as described in association with FIG. 17A.

FIG. 18A is a block diagram 1100 schematically representing a leadassembly 1102 including an associated attenuation arrangement, accordingto one example of the present disclosure. In some examples, the leadassembly 1102 comprises a FPE region 1130 and a non-FPE region 1132 withdashed lines 1133 representing a boundary between the two respectiveregions 1130, 1132. The non-FPE region 1132 is co-extensive with theelectrode portion 1122 and indicates that the portion of the leadassembly 1102 in non-FPE region 1132 is constructed via elements andtechniques other than a FPE assembly (FIGS. 6A-17B). Meanwhile, the FPEregion 1130 is co-extensive with the lead 1112 and active element 1125and indicates that the portion of the lead assembly 1102 in region 1130is at least partially defined by a FPE assembly. In some examples, suchan FPE assembly may comprise at least some of substantially the samefeatures and attributes as at least some of the FPE assemblies aspreviously described in association with at least FIGS. 2, 5A-17B, and19-33. Accordingly, in some examples, in addition to active attenuationelement 1125, the lead 1112 includes one or several attenuationmodalities (at least 212, 214, 216, 217 in FIG. 5A).

As shown in FIG. 18A, lead 1112 extend between a proximal end 1115 and adistal end 1113 with active element 1125 at the distal end 1113 suchthat active element 1125 is interposed between the more proximalportions of lead 1112 and the non-FPE region 1132 of the lead assembly1102. Among other potential components, lead 1112 includes at least apair of signal conductive elements 1141, 1142 (e.g. 514A, 514B in FIG.7) extending from proximal end 1115 to a position just short of thedistal end 1113 at which the signal conductive elements are electricallyand physically coupled to a proximal end 1127B of the active element1125. Meanwhile, at its distal end 1127A the active element 1125 isphysically and electrically coupled to the electrode portion 1122 viaconductive elements 1151A, 1151B, 1153C to control contact electrodes E.

It will be understood that the number of conductive elements (e.g. 1141,1142) in lead 1112 and the number of conductive elements (e.g. 1151A,1151B, 1151C) in the non-FPE region 1132 may vary from the number shownin FIG. 18A.

In some examples, the active element 1125 may comprise a RF choke oractive element that is normally open, but which may receive a signalfrom an IPG (e.g. 104 in FIG. 2) to isolate the lead 1112 from theelectrodes E in electrode portion 1122.

In some examples, the active element 1125 may include circuitry toreceive signals from the lead 1112 and process them before transmittingcontrol signals to apply stimulation signal to electrodes E in a desiredpattern to implement a stimulation therapy regimen via electrode portion1122.

In addition, the active element 1125 electrically and physicallyisolates the conductive elements 1141, 1142 extending throughout thelength of lead 1112 from the contact electrodes E in the electrodeportion 1122. By doing so, the active element 1125 prevents the RFenergy (that may become coupled to the much longer conductive elements1141, 1142 of the lead 1112) from reaching the electrodes E, and therebyminimizes heating at electrodes E.

In this regard, it will be further noted that the conductive elements1151A, 1151B, 1151C have a relatively short length (L4). In someexamples, this length L4 is least one or two orders of magnitude lessthan a length L5 of the conductive elements 1141, 1142 of the lead 1112and at least one or two orders of magnitude less than a wavelength ofthe MRI signals (within the body). Accordingly, given their relativelyshort length, it may be expected that a relatively small amount of RFenergy could couple onto those conductive elements 1151A, 1151 B, 1151C,and therefore an insignificant amount of heating may result. In someexamples, the length L4 may be in the range of less than 5 centimeters.

Accordingly, because the conductive elements 1151A-1151C in the non-FPEregion 1132 are relatively short and are electrically isolated from therelatively long conductive elements 1141, 1142 in lead 1112, thisarrangement inhibits large amounts of MRI RF energy from becomingcoupled onto conductive elements 1151A-1151C. This arrangement therebyalso inhibits large amounts of MRI RF energy from becoming coupled ontoelectrodes E in electrode portion 1122.

In some examples, a combination of the electrodes E and the conductiveelements 1151A, 1151B, 1151C have a relatively short length (L10)relative to the entire lead 1112. In some examples, this length L10 isleast one or two orders of magnitude less than a length L5 of theconductive elements 1141, 1142 of the lead 1112 and at least one or twoorders of magnitude less than a wavelength of the MRI signals (withinthe body). Accordingly, given this relatively short length, it may beexpected that a relatively small amount of RF energy could couple ontothose conductive elements 1151A, 1151B, 1151C and/or electrodes E, andtherefore an insignificant amount of heating may result. In someexamples, the length L10 may be in the range of less than 10centimeters. In some examples, the length L10 may less than about 2centimeters.

It will be understood that, in some examples the lead assembly 1102 caninclude other attenuation modalities embodied in the FPE assembly whichat least partially defines the lead 1112, with such attenuationmodalities (e.g. 210-217) being described in association with at leastsome of the examples in FIGS. 5A-33. Moreover, in some examples, thenon-FPE region 1132 also can include some attenuation modalities, suchas an external shield, some of which are described throughout at leastsome of examples throughout the present disclosure.

FIG. 18B is a block diagram 1150 schematically representing a leadassembly 1152 including an associated attenuation arrangement, accordingto one example of the present disclosure. As shown in FIG. 18B, in someexamples substantially the entire length of the lead assembly 1152 is atleast partially defined by a FPE assembly 1153, which comprises at leastsome of substantially the same features and attributes as at least someof the FPE assemblies as described in association with at least FIGS. 2,5A-17B, and 19-33. As shown in FIG. 18B, in some examples an entirelength of the lead assembly 1152 is defined by such a FPE assembly 1153.

Accordingly, as shown in FIG. 18B, even the region 1145 (dashed box) inwhich electrode portion 1157 is located is defined by an FPE assembly1153. Stated differently, the FPE assembly 1153 is co-extensive with theelectrode portion 1157 as well as with the lead 1142 proximal to theelectrode portion 1157.

FIG. 18C is a sectional view of FIG. 18B as taken along lines 18C-18Cand schematically representing a cuff electrode 1160 defined by a FPEassembly, according to one example of the present disclosure. As shownin FIG. 18C, cuff electrode 1160 comprises a generally circularcross-sectional shape having an outer surface 1162 and an inner surface1164 defining a lumen 1161 sized for releasable engagement about a nerveor other body tissue. In some examples, the wall W of the cuff electrode1160 is defined by a FPE structure (e.g. FPE assembly 1170 in FIG. 18D).In some examples the FPE structure comprises substantially the samefeatures and attributes as the FPE assembly defining the lead assembly1152. In some examples, the FPE structure defining the cuff electrode1160 at least some features and attributes other than those of FPEassembly defining the lead assembly 1152.

In addition, in some examples, the electrode portion 1157 of leadassembly 1152 in FIG. 18B is embodied in a configuration other than acuff electrode, and as such, can be a paddle electrode, etc.

As shown in FIG. 18C, a contact electrode 1167 extends along at least aportion of the inner surface 1164 of the cuff electrode 1160.

In some examples, the FPE structure defining the wall of the cuffelectrode or defining the lead body may take the form shown in FIG. 18D.Accordingly, FIG. 18D is a sectional view schematically representing aFPE assembly 1170, according to one example of the present disclosure.

As shown in FIG. 18D, the FPE assembly 1170 comprises substantially thesame features and attributes as FPE assembly 502 in FIG. 7E, exceptfurther comprising a contact electrode 1167. In some examples, thecontact electrode 1167 may be used to transmit a stimulation signal to abody tissue, sense physiologic information from a body tissue, and/orfor other purposes.

In some examples, the contact electrode 1167 is embedded withininsulator 520C. In some examples, vias 1172A, 1172B extend internallyand vertically from contact electrode 1167 to be electrically coupledrelative to one or both of the signal conductive elements 514A, 514B. Insome examples, an insulative region 1180A, 1180B electrically isolatesthe conductive vias 1172A, 1172B from the shield conductive element(e.g. layer) 517B. In some examples, when appropriate based on the typeof signals being transmitted and/or received, an insulative region 1182is provided to electrically isolate the conductive via 1172A from signalconductive element 514B.

In some examples, because the contact electrode 1167 is located on abottom surface 408B of the FPE assembly 1170, which also defines theinner surface 1164 of the cuff electrode 1160, the contact electrode1167 is generally shielded by the other shielding elements 517A, 517B ofthe FPE assembly 1170.

Accordingly, the contact electrode, signal conductive elements, andshielding functionality can be incorporated into a monolithic structure(e.g. a single unitary piece) defined by a FPE assembly.

In some examples, the electrode portion 1157 of lead assembly 1852 inFIG. 18B may comprise a cuff electrode arrangement having at least someof the features and attributes as cuff electrode 3100 in FIGS. 18E-18G,cuff electrode 3200 in FIGS. 18H-18I, cuff electrode 3300 in FIGS.18J-18K, cuff electrode 3400 in FIGS. 18L-18M, and/or cuff electrode3500 in FIGS. 18N-18O.

With this in mind, FIG. 18E is an isometric view of a cuff electrode3100 which may serve as one implementation of electrode portion 1157 inFIG. 18B and/or electrode 102 (FIG. 2). As shown in FIG. 18E, cuffelectrode 3100 comprises a cuff body 3101 defining a lumen 3140 via atleast opposing, resilient flange members 3134 and 3150, which are eachshaped, sized, and biased to cause their respective ends 3151 and 3153to releasably contact each other (or nearly contact each other) at 3109.Via this arrangement, the cuff body 3101 may be self-sizing fordifferently sized nerves and/or to accommodate nerve swelling. An array3102 of electrodes 3103A-3103C are spaced apart along a length (L6) ofcuff body 3101 between ends 3107, 3108.

In some examples, cuff body 3101 may comprise a base 3120 which maycontain electrical conductors for connecting lead 72 to the electrodes3103A-3103C and/or to at least partially house elements whichmechanically support electrodes 3103A-3103C.

In some examples, the electrodes 3103A-3103C form part of a flexibleprinted electronics (FPE) assembly 3155 such as FPE assembly 1170 (FIG.18D). In at least one such arrangement, each electrode 3103A-3103C maycomprise one example of a respective contact electrode 1167 in FIGS.18C-18D. In some examples, FPE assembly 3155 in FIG. 18E may have agreater number or fewer number of conductors, insulators, and/or shieldelements shown in FIG. 18D. Moreover, in some examples, FPE assembly3155 also may implement at least one of the attenuation modalities, suchas the filter, anti-phase, dissipation, shield modalities as describedin association with at least FIGS. 5A-5D and elsewhere throughoutexamples of the present disclosure.

However, it will be understood that in some examples, FPE assembly 3155does not define the entire cuff body 3101. Rather, cuff body 3101 ismolded or otherwise formed to incorporate FPE assembly 3155 (includingelectrodes 3103A-3103C). In some examples, electrodes 3103A-3103C may beformed via a non-FPE structure and then electrically and mechanicallyattached to the FPE assembly 3155. However, in some examples, electrodes3103A-3103C may be formed as part of and/or incorporated within the FPEassembly 3155. In some examples, FPE assembly 3155 may be considered tobe integral with the rest of cuff body 3101.

In some examples, at least those portions of the electrodes 3103A-3103Cand/or of the FPE assembly 3155, which may be exposed to contact withbodily tissues and/or fluids, are made of biocompatible material and/orcoated with a biocompatible material. In some examples, the biomaterialcomprises a platinum/iridium material or a platinum black-basedmaterial.

As further shown in the sectional view of FIG. 18F, in some examples,cuff body 3101 may comprise at least one resilient flange member 3160biased to at least partially overlap flange members 3150, 3134 and thepoint of releasable contact 3109, thereby further defining lumen 3140and providing for more robust releasable engagement about a nerve withinlumen 3140. Meanwhile, FIG. 18G provides another sectional view of thecuff electrode 3100 illustrating the electrodes 3103A-3103C spaced apartlongitudinally along cuff body 3101.

FIG. 18H is an isometric view schematically representing an example cuffelectrode 3200 which comprises at least substantially the same featuresand attributes as cuff electrode 3100 (FIGS. 18E-18G), except with cuffbody 3201 omitting a base like base 3120 in FIG. 18E. Instead, cuff body3200 comprises a base 3220 which generally conforms to a generallyuniform contour of the external surface 3223 of cuff body 3200. Likecuff electrode 3100, cuff electrode 3200 incorporates a FPE assembly3155 as previously described in association with cuff electrode 3100. Insome examples, the presence of the FPE assembly 3155 in cuff electrode3200 may contribute to the omission of base 3120 (FIGS. 18E-18G) atleast because FPE assembly 3155 already comprises signal conductorswhich were formerly conveyed to the electrodes 3103A-3103C via base3120. Moreover, as previously mentioned in association with FIGS.18E-18G, the FPE assembly 3155 in cuff electrode 3200 may incorporatevarious attenuation tools previously described in FIGS. 5A-5D andelsewhere throughout examples of the present disclosure.

As shown in FIG. 18I, in some examples, a third flange member 3260 (like3160 in FIG. 18F) extends from, and is part of, flange member 3250. Insome examples, a shelf 3251 is defined at junction of third flangemember 3260 and flange member 3250 with shelf 3251 comprising an end offlange member 3250 at which releasable engagement of end 3153 of flange3134 may take place.

FIG. 18J is an isometric view schematically representing another examplecuff electrode 3300 which may be one implementation of the electrodeportion 1157 in FIG. 18B to provide an array 3302 of electrodes3303A-3303C longitudinally spaced apart between ends 3307 and 3308. Insome examples, cuff electrode 3300 may be formed entirely orsubstantially entirely of a FPE assembly 3355, such as but not limitedto FPE assembly 1170 in FIGS. 18C-18D. In such an arrangement, eachelectrode 3303A-3303C comprises a contact electrode 1167 of FPE assembly1170 in FIGS. 18C-18D. In some examples, FPE assembly 3355 may comprisea greater or fewer number of the respective insulators, conductors,shield elements, etc. of FPE assembly 1170, as well as various elementsto implement at least one of the filter, dissipation, shielding, andanti-phase modalities of the attenuation tools in FIGS. 5A-5D. FIG. 18Kis a sectional view further illustrating one example arrangement of cuffbody 3301 formed via FPE assembly 3355.

In some examples, additional flange members such as overlapping flangemember 3260 (FIG. 18H-18I) may be formed as part of FPE assembly 3355 orovermolded onto FPE assembly 3355 so as to provide for releasableengagement and overlap relative to cuff body 3301, including point 3309of releasable engagement of opposing ends 3353, 3351 of resilient arms3334, 3335 of cuff body 3301.

FIGS. 18L-18M schematically represent a cuff electrode 3400, whichprovides another example implementation of the electrode portion 1157 inFIG. 18B, which may be formed as part of a FPE assembly 1153 (FIG. 18B),1170 (FIG. 18D). Cuff electrode 3400 comprises at least substantiallythe same features as cuff electrode 3300 except further comprisingadditional electrodes 3403B, 3405B such that electrodes 3303B, 3403B,3405B are arranged in a spaced apart circumferential pattern about cuffbody 3401 as shown in FIG. 18L and the sectional view of FIG. 18M. Amongother features, this arrangement may enable selective stimulation withinand/or along a nerve via the independently activatable/programmableelectrodes 3303A, 3303B, 3303C, 3403B, 3405B to achieve differentselectable stimulation vectors.

FIGS. 18N-18O schematically represent a cuff electrode 3500, whichprovides another example implementation of the electrode portion 1157 inFIG. 18B, which may be formed as part of a FPE assembly 1153 (FIG. 18B),1170 (FIG. 18D). Cuff electrode 3500 comprises at least substantiallythe same features as cuff electrode 3400 except further comprisingadditional electrodes 3503A, 3505A, 3503C, 3505C such that all of therespective electrodes on cuff body 3501 are arranged in a spaced apartcircumferential pattern and/or spaced apart longitudinal pattern on cuffbody 3501 as shown in FIG. 18N and the sectional view of FIG. 18O. Amongother features, this arrangement may enable selective stimulation withinand/or along a nerve via the independently activatable/programmableelectrodes 3303A, 3303B, 3303C, 3403B, 3405B, 3503A, 3505A, 3503C, 3505Cto achieve different selectable stimulation vectors.

FIG. 19A schematically represents at least some aspects of anattenuation arrangement 3610 for a lead 3600 and FIG. 19B is a partialsectional view of FIG. 19A, according to one example of the presentdisclosure. In some examples, lead 3600 may comprise at least some ofsubstantially the same features and attributes as any one of the leads(and/or implantable medical devices) described in association with atleast FIGS. 1-18O. In some examples, the attenuation arrangement 3610may comprise one example implementation of at least the anti-phasemodality 217 and/or anti-phase elements 253 in FIGS. 5A-5D. In someexamples, the attenuation arrangement 3610 may serve to implement acombination of the at least the various modalities 212, 214, 216, 217(FIG. 5A).

In some examples, FIG. 19A schematically represents a top view of lead3600 demonstrating an attenuation arrangement 3610 extendinglongitudinally (along orientation F) along a length of lead 3600 and/orextending laterally (along orientation S) across a width of lead 3600.Moreover, it will be understood that in some examples the attenuationarrangement 3610 is incorporated within a non-conductive body 3603 oflead 3600, such that attenuation arrangement 3610 may be located justbelow an exterior surface of lead 3600. In some examples, FIG. 19Arepresents a top view of lead 3600 such that the portion of attenuationarrangement 3610 depicted in FIG. 19A would correspond to theattenuation arrangement 3610 generally extending over an entire topportion of lead 3600.

In some examples, the attenuation arrangement 3610 extends about anentire periphery of the lead 3600 to completely surround signalconductors and/or other elements within an interior of the lead 3600.Accordingly, the view in FIG. 19A may also schematically represent abottom view, side view, etc. of lead 3600 and attenuation arrangement3610 positioned near a bottom, side, etc. of lead 3600, respectively.

As further shown in FIG. 19A, in some examples attenuation arrangement3610 comprises several rows 3620A, 3620B, 3620C, with each respectiverow comprising a plurality of conductive loops 3622 aligned generallyparallel to a longitudinal axis of lead 3600 (along orientation F). Insome examples, the respective conductive loops 3622 are joined togethervia straight conductive segments 3623 such that the conductive loops3622 in a given row may comprise a continuous conductive element in someexamples. In some examples, each row 3620A-3620C has lengthsubstantially the same as a length of lead 3600.

In some examples, the respective loops 3622 are spaced apart from eachother both longitudinally and laterally. In some examples, each loop3622 has a depth as shown in the sectional view of FIG. 19Bcorresponding to a single loop of conductive material before a straightsegment 3623 provides a transition to an adjacent loop 3622 along thelength or across the width of the lead 3600.

In some examples, the consecutive pattern of loops 3622 may beunderstood to proceed in a forward direction from one end of theattenuation arrangement (and therefore of lead 3600) to an opposite endof the attenuation arrangement (and therefore of lead 3600) by which thesignal is pathway proceeds longitudinally forward. In some suchexamples, the continuous pattern of consecutive loops 3622 within agiven row (e.g. 3630A, 3630B, 3630C) do not reverse course in anopposite direction and/or do not reverse course in an opposite directionin any significant way before resuming a forward direction again.

In some examples, the loop 3622 may be considered as providing aninductive effect with rows of loops 3622 (in the longitudinal and/orlateral orientation) thereby acting to dissipate RF energy from anexternal source, such as an MRI or other RF source. In particular, suchan arrangement of loops 3622 may provide an anti-phase modality 217(FIGS. 5A-5D) to effectively cancel RF energy which may otherwisepropagate as e-fields along a length of lead 3600.

In some such examples, because the attenuation arrangement 3610 does notcomprise a signal conductor, a continuous portion of a conductor whichdefines a given row (e.g. 3630A) of conductive loops 3622 may have endswhich terminate without connection to an electrode or electricalcontact. Stated differently, in at least some examples, eachconductor(s) forming each respective row of conductive loops maysometimes be referred to as a non-signal conductor. In this way, in someinstances the attenuation arrangement 3610 may be understood as beingseparate from, and independent of, any electrodes and/or electricalcontacts to which a separate signal conductor is connected.

In some examples, a substrate (e.g. base insulator 508 in FIG. 7A, 510in at least FIG. 7B) onto which loops 3622 are formed or printed doesnot reverse direction between the ends of the substrate, but ratherextends in a single, forward direction.

However, in some examples, each conductive loop 3622 depicted in theview of FIG. 19A may comprise a plurality 3662 of spaced apart loops3622 extending a greater depth, as shown in the sectional view of FIG.19C, before a straight segment 3623 provides a transition to an adjacentloop 3622 along the length or across the width of the lead 3600.

In such arrangements, the plurality of loops 3625 extending for a depthat each position of the (main) loop 3622 may enhance the anti-phaseand/or inductive influence on RF energy directed at the lead 3600.

It will be understood that in at least some examples, the rows 3620A,3620B, 3620C of conductive loops of attenuation arrangement 3610 do notserve as signal conductors. In some examples, the rows of conductiveloops of attenuation arrangement are independent of (e.g. not connectedto) an electrode used for sensing and/or stimulation. Rather, insteadthe lead comprising the attenuation arrangement 3610 comprises otherconductive elements which may serve as signal conductors.

FIG. 19D is a sectional view schematically representing at least someaspects of an attenuation arrangement 3680, according to one example ofthe present disclosure. In some examples, the attenuation arrangement3680 comprises at least some of substantially the same features andattributes as attenuation arrangement 3660 (FIG. 19C), except includingat least one capacitive structure 3682 among rows of pluralities 3625 ofconductive loops 3622, which may act as inductive structures. In oneaspect, the presence of at least some capacitive structures among thepluralities 3625 of conductive loops 3622 may contribute to the shield,filter, dissipation, and/or anti-phase modalities 212, 214, 216, 217(FIGS. 5A-5D).

FIG. 19E schematically represents an attenuation arrangement 3690comprising at least one row 3691 of generally rectangular-shapedconductive loops 3692, according to one example of the presentdisclosure. In some examples, attenuation arrangement 3690 comprises atleast some of substantially the same features and attributes as at leastone of the attenuation arrangements 3610, 3660, 3680 as described inassociation with at least FIGS. 19A-19D, except with conductive loops3692 having a generally rectangular shape. In some examples, therespective straight segments 3693 connect adjacent loops 3692. In someexamples, as compared to the generally circular-shaped loops describedabove, the generally rectangular shaped loops 3692 are more amenable toconstruction in an FPE assembly.

FIG. 19F schematically represents an attenuation arrangement 3700comprising a row 3701 of overlapping circular-shaped conductive loops3702 according to one example of the present disclosure. In someexamples, attenuation arrangement 3700 comprises at least some ofsubstantially the same features and attributes as at least one of theattenuation arrangements 3610, 3660, 3680 as described in associationwith at least FIG. 19A, except with conductive loops 3702 overlappingeach other. Straight segments 3703 connect the loops 3702 together. Viasuch overlap, in some examples this arrangement may more efficientlydissipate local RF energy along the lead body at the stimulationelectrode and/or provide a greater inductance and therefore enhancedfiltering of RF energy.

FIG. 19G schematically represents a lead 3750 comprising an attenuationarrangement 3760 and signal conductors 3630A, 3630B, according to oneexample of the present disclosure. In some examples, the attenuationarrangement 3760 comprises rows 3770A-3770C of conductive partial loops3772. In some examples, the attenuation arrangement 3760 comprises atleast some of substantially the same features and attributes as theattenuation arrangements 3610 (FIG. 19A), except with each conductivepartial loop 3772 comprising at least one integrated passive device3774. In some examples, the integrated passive device 3774 comprises aninductive element (e.g. 250 in FIGS. 5A-5C). In some examples, theintegrated passive device 3774 comprises elements other than aninductive element which may contribute to at least the anti-phasemodality 217 (FIGS. 5A-5D), among other attenuation modalities 212, 214,216 (FIGS. 5A-5D).

FIG. 19H schematically represents a lead 3800 comprising an attenuationarrangement 3805, according to one example of the present disclosure. Aspreviously noted in association with FIG. 19A, the view in FIG. 19H mayrepresent a top view, side view, or bottom view of the lead 3800. Asshown in FIG. 19H, lead 3800 comprises at least one signal conductor3630A, 3630B extending along a length of lead 3800 (extending inorientation F) and with the attenuation arrangement 3805 positioned tointercept RF energy and prevent or minimize its coupling onto the signalconductors 3630A, 3630B.

As shown in FIG. 19H, the attenuation arrangement 3810 comprises rows3810A, 3810B of capacitive conductive structures 3822 (relative to acontinuous straight segment 3824) positioned near an exterior surface(e.g. a side, top, etc.) 3602A, 3602B of the lead 3800. In one aspect,the conductive structures 3822 may implement at least a shield modality(212 in FIGS. 5A-5D) while capacitively coupling the shield (structures3822) relative to surrounding tissue to facilitate dissipation of theunwanted RF energy into the tissue and away from signal conductors3630A, 3630B (and/or electrodes) in lead 3800.

FIG. 19I schematically represents a lead 3850 comprising an attenuationarrangement 3855, according to one example of the present disclosure. Insome examples, lead 3850 comprises at least some of substantially thesame features and attributes as lead 3800 (FIG. 19H), except foromitting the capacitive structures 3822 near at least one outer wall(e.g. 3602B) of the lead 3850. Instead, a shield conductive element 3857having a structure other than capacitive structures 3822 is positionednear one outer wall (e.g. opposite side or bottom 3602B). In thisarrangement, the shield conductive element 3857 may be capacitivelycoupled to interstitial fluid, while the row of conductive structures3822 facilitate capacitive coupling relative to surrounding tissuesadjacent surface 3620A of lead 3850 such that row 3810A may act as ashield while directing energy for dissipation in the surrounding tissue.

FIG. 20A is side view schematically representing a lead assembly 4000,according to one example of the present disclosure. In some examples,lead assembly 4000 comprises a lead 4012 and a conductive arrangement4020 circumferentially surrounding the lead 4012. In some examples, atleast some aspects of the lead assembly 4000 comprises at least some ofsubstantially the same features and attributes as the various leads andlead assemblies, including an attenuation arrangement, as described inassociation with at least FIGS. 1-19O. In some examples, lead 4012 mayincorporate at least some aspects of an attenuation arrangement and insome examples, lead 4012 may omit aspects of an attenuation arrangement.

As shown in FIG. 20A, in some examples the conductive arrangement 4020may be located external to lead 4012 and extend generally parallel tolead 4012 and at least between opposite ends 4013, 4015 of lead 4012. Insome examples, conductive arrangement 4020 comprises an array 4022 ofouter (O) conductive structures 4030 and an array 4024 of inner (I)conductive structures 4030 with dashed line E providing a referencepoint relative to which the respective inner positions and outerpositions are identified. In some examples, a first plurality ofsubstantially identical conductive structures 4030 at least partiallydefines array 4022 and a second plurality of substantially identicalconductive structures 4030 at least partially defines array 4024. Insome examples, some conductive structures 4030 identified via referenceA may define conductive structures which have electrical continuity witheach other along a length (L8) of the lead assembly 4000, with theseconductive structures (A) alternating between having an inside (I) andan outside (O) position relative to reference line E. Similarly, in someexamples, some conductive structures 4030 identified via reference B maydefine conductive structures which have electrical continuity with eachother along a length (L8) of the lead assembly 4000, with theseconductive structures (B) alternating between having an inside and anoutside position relative to reference line E. Via this arrangement, insome examples the “A” conductive structures 4030 form a repeatingpattern of alternating inside and outside position. In some instances,the inside position (I) of the “A” conductive structures 4030 may besometimes be referred to being inverted relative to the outside position(O), or vice versa. Similarly, in some instances, the inside position(I) of the “B” conductive structures 4030 may be sometimes be referredto being inverted relative to the outside position (O), or vice versa.Moreover, in some instances, each switch or inversion of the “A”structures and “B” structures may sometimes be referred to as atransition.

In some examples, each conductive structure 4030 (A and/or B) comprisessome conductive elements (e.g. wire, conductive trace, etc.) arranged ina pattern adapted to attenuate RF energy in some manner.

In some examples, at least the “A” conductive structures 4030 togetherform a single conductive structure extending the length of the lead4012. In some examples, at least the “B” conductive structures 4030together form a single conductive structure extending along the lengthof the lead 4102. In some such examples, the “A” conductive structures4030 and the “B” conductive structures 4030 together form a singleconductive structure, such as a coil. As described in further detaillater in association with at least FIGS. 20E, in some examples the “A”conductive structures 4030 and “B” conductive structures 4030 may beimplemented via a single coil or multiple coils which are formed toalternate between an inside and an outside position.

In some examples, as later shown in the diagram FIG. 20G, the entireattenuation arrangement 4020 may be understood as being formed from oras a single continuous conductive element 4830 which travels a fulllength (L20) of the attenuation arrangement 4020A (and therefore a fulllength of at least the protected portion of the lead) twice, with thesingle continuous conductive element extending from an initial end 4810in a first (e.g. forward FWD) direction before making a single reversalof direction 4802 one time at one end 4805 of the attenuationarrangement (and therefore one end of at least the protected portion ofthe lead) before extending in an opposite, second (e.g. reverse)direction (R) to the initial end 4810 of the attenuation arrangement. Indoing so, in at least some such examples, the single conductive elementforming attenuation arrangement does not change direction again toresume travel in the first/forward direction after the attenuationarrangement completes the initial reversal in direction. Stateddifferently, the opposite terminal ends 4812A, 4812B of the conductorforming the attenuation arrangement are located at the same end 4810 ofthe lead. It will be understood that FIG. 20G omits features such ascoils and/or position inversions for illustrative simplicity and/orclarity in order to demonstrate the above-described generalrelationships exhibited in an attenuation arrangement (e.g. 4020 in FIG.20A) in at least some examples of the present disclosure.

In some instances, at least some of the example arrangements describedin association with FIG. 20A may comprise one implementation of at leastshield modality 210 and/or an anti-phase modality 217 (e.g. also element253), as described in association with at least FIGS. 5A-5D. Inparticular, the repeating pattern of alternating inside/outsidepositions of the “A” and “B” conductive structures 4030 may cause phasesof RF e-fields to be in opposition such that phases on inside andoutside (relative to reference line E) cancel each other. As such, thealternating patterns of “A” conductive structures 4030 and “B”conductive structures 4030 of conductive arrangement 4020 may sometimesbe referred to as an anti-phase arrangement or as a phase-cancellationarrangement.

As shown in FIG. 20A, each “A” or “B” conductive structure 4030 has alength L7 which forms a portion of a total length L8 of the entireconductive arrangement 4120. In some examples, the length L7 maycomprise about 5 percent to about 20 percent of the total length L8 ofconductive arrangement 4120, such that inversions (of the “A” or “B”conductive structures 4030) between the respective inside (I) andoutside (O) positions occur with a frequency based on the length L7. Forinstance, if length L7 is about 5 percent of the total length L8, thenabout 20 inversions (e.g. switches between the inside and outsideposition) would occur for “A” conductive structures 4030 (or for “B”conductive structures 4030) over the entire length of the conductivearrangement 4020. In some examples, the length L7 is the same for eachconductive structure 4030. However, in some examples, some conductivestructures 4030 may have lengths other than a length L7.

In some examples, the length L7 of the “A” or “B” conductive structures4030 may comprise about two to three percent of the total length L8 suchthat much higher frequency of inversions take place for the “A” and “B”conductive structures 4030. For instance, if length L7 is about 2percent of the total length L8, then about 50 inversions (e.g. switchesbetween the inside and outside position) would occur for the “A” and “B”conductive structures 4030 over the entire length of the conductivearrangement 4020. Because of the high frequency of position inversions,such example arrangements may be more readily implemented via one of theexample flexible printed electronic (FPE) assemblies, whether the FPEassembly is separate from the lead 4012 (e.g. FIG. 20A) or the FPEassembly is at least partially incorporated into the lead (e.g. FIG.20B, 20C), such as when the lead is formed as a FPE assembly.

However, it will be understood that the attenuation arrangement 4020 maybe implemented in non-FPE arrangements, i.e. structures which do notemploy an FPE assembly to form the conductive arrangement 4020 and/orfor the lead 4012. For instance, at least some of the examples describedin association with at least FIGS. 21A-33, which may comprise a coilstructure, may be implemented in an attenuation arrangement such as inFIG. 20A to implement an anti-phase modality 217 (FIG. 5A-5D).

FIG. 20B is a side view schematically representing a lead assembly 4100,according to one example of the present disclosure. In some examples,lead assembly 4100 comprises a lead 4112 and a conductive arrangement4120 circumferentially surrounding the lead 4012 with at least a portionof conductive arrangement 4120 incorporated within a portion of lead4112. Accordingly, in some examples lead assembly 4100 comprises atleast some of substantially the same features and attributes as leadassembly 4000 (FIG. 20A), except with a portion (e.g. array 4122 ofalternating “A”, “B” conductive structures 4130) of arrangement 4120external to lead 4112 while another portion (e.g. array 4124 ofalternating “A”, “B” conductive structures 4130) of conductivearrangement 4120 is internal to or incorporated within lead 4112.

In some examples, the conductive arrangement 4120 provides one exampleimplementation of at least shield modality 210 and/or an anti-phasemodality 217 (or element 253), as described in association with at leastFIGS. 5A-5D, which may be employed to minimize the impact of external RFenergy on conductors 4117 within lead 4112.

FIG. 20C is side view schematically representing a lead assembly 4200,according to one example of the present disclosure. In some examples,lead assembly 4200 comprises at least some of substantially the samefeatures and attributes as lead assembly 4000, 4100 as described inassociation with at least FIGS. 20A-20B, except with the entireconductive arrangement 4220 being incorporated within or as part of lead4112. In other words, the entire conductive arrangement 4220 is locatedwithin outer wall(s) 4219, 4221 of lead 4112 and is within the oppositeends 4013, 4015 of lead 4212.

In some examples, conductive arrangement 4220 circumferentiallysurrounds signal conductors (and/or other conductors) 4117, which may belocated at an interior of lead 4212. However, in some examples, theconductive elements of conductive arrangement 4220 also may act assignal conductor(s) along a length of the lead, with the alternatinginside/outside pattern of “A”, “B” conductive structures 4230 providinga shield modality 210/212 and/or anti-phase modality 217 (also 253) asin FIGS. 5A-5D.

It will be understood that the various lead assemblies 4000, 4100, 4200(FIGS. 20A-20C) may be implemented according to leads having a widevariety of different cross-sectional shapes, such as circular,elliptical, rectangular, etc.

In some examples, an arrangement of alternating pattern of conductivestructures 4230 may be implemented across a width (e.g. laterally) of alead, as shown in the sectional view of FIG. 20D. In particular, asshown in FIG. 20D, groups 4332, 4334 of conductive structures 4230 arearranged in an alternating pattern (represented via A, B) analogous tothat shown in FIG. 20C, except for extending laterally instead oflongitudinally (along the length of the lead). A width (W6) of theconductive structures 4230 forms a portion of the total width (W5)between opposite sides 4329, 4331 with width (W6) selectable to achievea desired number of inversions laterally, in a manner similar todescribed above for FIGS. 20A, 20B, in order to achieve a desired degreeof implementation of the shield and/or anti-phase modalities 212, 217(FIGS. 5A-5D).

FIG. 20E is a side sectional view schematically representing a coilstructure 4400, according to one example of the present disclosure. Inparticular, coil structure 4400 may comprise one example implementationof an anti-phase modality (e.g. 217, 253 in FIGS. 5A-5D) and/or shieldmodality (e.g. 210, 212 in FIG. 5A-5D) of an attenuation arrangement inthe manner described in association with at least FIG. 20A. Accordingly,in some examples, coil structure 4400 may comprise at least some ofsubstantially the same features and attributes as the attenuationarrangements described in association with at least FIGS. 20A-20D.

As shown in FIG. 20E, in some examples the coil structure 4400 may beunderstood as having two halves 4410A, 4410B on opposite sides of acenterline C aligned in a first orientation (F).

For instance, as shown in FIG. 20E, upon considering one half 4410A ofcoil structure 4400, it may be seen that a group 4420 of coils (e.g. 1,2, 3, 4 in dashed circles) may correspond to one of the “A” conductivestructures 4030 in lead 4000 of FIG. 20A and a group 4422 of coils (e.g.4, 3, 2, 1 in solid circles) may correspond to one of “B” conductivestructures 4030 in lead 4000 in FIG. 20A. Moreover, dashed lines 4413Gand 4413H in FIG. 20E represent a reference by which particular portionsof each half 4410A, 4410B of the coil structure 4400 may be consideredto exhibit an inside position (I) or an outside position (O). However,the reference defined by dashed lines 4413G, 4413H does not generallycorrespond to a physical barrier between the “A” coils of groups 4420and “B” coils of groups 4422, except when the coil structure 4400 may bean example implementation of the example of FIG. 20B.

In a manner similar to FIG. 20A, at regular intervals (e.g. L7 in FIG.20A) the “A” conductive structures (e.g. 1, 2, 3, 4 in dashed circles)of coil structure 4400 in FIG. 20E experience a transition between aninside position (I) and an outside position (O) and the “B” conductivestructures (e.g. 4, 3, 2, 1 in solid circles) experience a transitionbetween an inside position (I) and an outside position (O). Stateddifferently, in some instances such transitions may sometimes bereferred to as regularly occurring inversions of the respective “A” and“B” conductive structures.

With this arrangement in mind, it may be understood that the regularlyoccurring transitions (e.g. inversions) between the inside (I) andoutside (O) positions of the respective “A” groups 4420 of coil portionsand “B” groups 4422 of coil portions may achieve an anti-phasecancellation in external RF energy, such as from an MRI field. Inparticular, this alternating pattern in coil structure 4400 may produceopposing phases of the e-fields of the MRI field, which cancel eachother out, which in turn may minimize the effect of these e-fields onthe signal conductors carried by a lead (having this coil structure 4400deployed in one of the configurations shown in at least FIGS. 20A-20D).

In some examples, coil structure 4400 in FIG. 20E may be implemented asone of the non-FPE coiled arrangements and/or FPE coiled arrangements asdescribed in association with at least FIGS. 21A-33.

FIG. 20F is an isometric view schematically representing a coilstructure 4600, according to one example of the present disclosure.

As shown in FIG. 20F, in some examples the coil structure 4600 comprisesa plurality of co-axial coils. In some examples, coil structure 4600comprises an outer coil 4610 and inner coil 4630, and an intermediatecoil 4620 interposed (circumferentially) between the outer coil 4610 andthe inner coil 4630. In one aspect, the outer coil 4610 and theintermediate coil 4620 are wound in opposite orientations, and with theinner coil 4630 being wound in the same orientation as the outer coil4610, and therefore an opposite winding orientation than theintermediate coil 4620.

In some examples, an outer coil 4610 and an intermediate coil 4620together provide a shield arrangement while an inner coil 4630 providesa signal conductor. In this way, the gaps between coil 4610 and 4620 areminimized while still providing the ability for the coils to flex alongthe length of the lead, in contrast with a contiguous shield that doesnot incorporate opposing coiled structures. In some examples, outer coil4610 and/or intermediate coil 4620 are arranged adjacent to tissue toprovide direct dissipation of RF energy. In some examples, outer coil4610 and/or intermediate coil 4620 are coated in an insulative materialprior to winding to provide capacitive dissipation of RF energy.

In some examples, outer coil 4610 and/or intermediate coil 4620 arecoated in an insulative material after winding to provide capacitivedissipation of RF energy. In some such arrangements, at least someportions of the respective outer and intermediate coils 4610, 4620 arein electrical contact, thereby forming a low impedance shield structureby virtue of electrical connection between opposing coils, whilemaximizing capacitive coupling to tissue.

In some examples, the size and/or shape of the respective outer andintermediate coils 4610, 4620 are formed and/or patterned in anarrangement which does not extend 360 degrees about the periphery of theinner coil 4630.

In some examples, coil structures 4500 or 4600 may be implemented as oneof the non-FPE coiled arrangements and/or FPE coiled arrangements asdescribed in association with at least FIGS. 21A-33.

In some of the previously described examples associated with at leastFIGS. 20A-20F, when such conductive arrangements are implemented via acoil structure formed as part of a FPE assembly, a substantially greaternumber of radial coils (e.g. 20) may be employed than in a non-FPEassembly (e.g. 3) because forming an FPE assembly can be performed in amanner permitting placing a much higher density of distinct radial coilswithin a given volume. In addition, in some examples in which theconductive arrangements of at least FIGS. 20A-20E are implemented via aFPE assembly, and to the extent that the conductive arrangements mayserve as a shield and/or anti-phase structure which are separate fromsignal conductors of a lead, then the signal conductors may take anydesired shape or form, and need not embody a coil shape.

In some examples, in which the example conductive arrangements of FIGS.20A-20E are implemented via a FPE assembly and such arrangements may actas a shield, at least some of the conductive structures extending alongthe length of the lead may be shorted at some locations.

In some examples in which the example conductive arrangements of FIGS.20A-20E may be implemented via a non-FPE assembly, each conductor mayextend twice the length (L8) of the lead body. In some such examples, afirst pass of the single conductor may comprise “A” conductivestructures 4030 and an opposite second pass of the single conductor maycomprise “B” conductive structures 4030. Accordingly, each conductorpasses through the MRI field (adjacent the lead) twice such that at eachpoint along the MRI field, the conductor is simultaneously exposed tothe MRI field and exposed to an inversion of the MRI field. Thisarrangement results in an effective cancellation of the phase(s) of theMRI field, thereby substantially absorbing a significant amount of RFenergy. In some examples, this arrangement may reduce the total energyabsorbed along the conductor and/or may reduce the amount of temperatureincrease occurring during exposure to a MRI field.

FIG. 21A is a perspective view schematically representing an implantablelead assembly 1200 including a FPE assembly 404 in a helically woundconfiguration and an outer tubular insulator 1202, according to oneexample of the present disclosure. In some examples, lead assembly 1200comprises at least substantially the same features and attributes aslead assembly 400 in FIG. 6A, except for further comprising an outertubular insulator 1202 through which the helically wound FPE assembly404 (and elongate support member 403) extends. As shown in FIG. 21A, theouter tubular insulator 1202 acts as a cover to protect the FPE assembly404 (and elongate support member 403) from body fluids, unwantedfibrotic growth, etc. In addition, the generally smooth outer surface1205 of the insulator 1202 may ease insertion and advancement of thelead assembly 1200.

In some examples, the outer tubular insulator 1202 may help to preventkinking of the lead assembly 1200, provide increased flex resistance,and/or provides a feel to the operator that more closely resembles atraditional lead structure. As previously described in association withat least FIG. 6A, the support member 403 also may help to preventkinking of the lead assembly 1200, provide increased flex resistance,and/or provides a feel to the operator that more closely resembles atraditional lead structure.

In some examples, the FPE assembly 404 omits an interior shield element,such as second shield conductive element 517B (and outer insulator 520Bin FIG. 16), such that shielding functionality is provided on just oneside (e.g. the exterior portion) of the FPE assembly 404 such as viafirst shield conductive element 517A, such as shown in FIG. 7D.

In some examples, elongate support member 403 is omitted from leadassembly 1200.

FIG. 21B is a perspective view schematically representing an implantablelead assembly 1250 including a lead subassembly 1210 and FPE assembly1260 as an external shield, according to one example of the presentdisclosure. In some examples, the subassembly 1210 comprises at leastsubstantially the same features and attributes as the lead assembly 1200in FIG. 21A, and therefore includes a first FPE assembly 404 (andelongate support member 403 therein) extending through a lumen 1206defined by outer insulator 1202. Via this arrangement, the first FPEassembly 404 may convey signals (e.g. sensing and/or stimulation) alonga length of lead assembly 1250. Accordingly, the first FPE assembly 404of the subassembly 1210 includes any one or several the attenuationmodalities 212, 214, 216, 217 in FIG. 5A, and in addition, exhibits thehelically wound configuration which provides additional shielding and/orfiltering functionality, as well as enhancing pushability, steerability,etc. of the lead assembly 1210.

As shown in FIG. 21B, the lead assembly 1250 includes a second FPEassembly 1260 helically wound about the outer insulator 1202 of the leadsubassembly 1210. An outer tubular insulator 1269 defines a lumen 1268through which the elements (1210, 1260) extend longitudinally, with theinsulator 1269 protecting FPE assembly 1260 from unwanted fibroticgrowth, body fluids, etc.

In one aspect, the second FPE assembly 1260 acts as an external shield,corresponding to at least the shield modality 210 in the attenuationarrangement 204 in FIG. 5A. Accordingly, in some examples the second FPEassembly 1260 embodies one or several of the attenuation elements ofarray 241 (FIG. 5A) such as a coil element 240 FIG. 5A (e.g. the 3D coilstructure of FIG. 9), a mesh structure 242 in FIG. 5A, FPE assembly 245,inductive element 250, and/or capacitive element 252.

As noted above, in some examples, the first FPE assembly 404 maycomprise one or several attenuation modalities (e.g. 212, 214, 216,217). Accordingly, in some examples, the lead assembly 1250 includesboth an external shield modality (e.g. 210 in FIG. 5A) and an internalshield modality (e.g. 212, 214, 216 in FIG. 5A). In such examples inwhich both the FPE assemblies 404, 1160 including shieldingfunctionality, the lead assembly 1250 comprises a double layer ofshielding for signal conductive elements 514A, 514B.

However, in some examples, the first FPE assembly 404 comprises noattenuation modalities and relies solely on the external shield providedvia the second FPE assembly 1260.

In some examples, the second FPE assembly 1260 omits signal conductiveelements (e.g. 514A, 514B) such that second FPE assembly 1260 does notconvey sensing signals and/or stimulation signals along the leadassembly 1250. In such examples, the second FPE assembly 1260 actssolely as an external shield, i.e. does not act to convey signals.However, in some examples, the second FPE assembly 1260 includes signalconductive elements (e.g. 514A, 514B) to convey signals, such the firstand second FPE assemblies 1210, 1260 form a coaxial arrangement in whichthe respective FPE assemblies 1210, 1260 carry signals independentlyfrom each other.

As shown in FIG. 21B, the second FPE assembly 1260 is in a helicallywound configuration of windings 1166 having a gap G4A between adjacentwindings. In some examples, the gap G1 between adjacent windings 406 ofthe first FPE assembly 404 is larger than the gap G4A between adjacentwindings 1266 of second FPE assembly 1260, thereby providing moreflexibility. In some examples, the smaller gap G4A between adjacentwindings 1266 of the is selected to enhance shielding, such as when thegap G4A is at least one order of magnitude less than a wavelength of theMRI-energy field signals (within the body). In some examples, the gapG4A is at least two orders of magnitude less than a wavelength of theMRI-energy field signals (within the body). In some examples, thethickness (T10) of outer tubular insulator 1269 may be and/or the gapG4A may be minimized in order to increase capacitive coupling to bodytissue, thereby enhancing shielding of RF energy.

In some examples, deploying the helically wound (e.g. coiled)configuration of the second FPE assembly 1260 about the lead subassembly1210 may help to prevent kinking, may increase mechanical flexresistance, and/or may enhance a more traditional operational feel whenhandling the lead assembly 1250. In one aspect, enhancing the mechanicalflex resistance may enhance overall reliability of the first FPEassembly 404 because the coil 1290 protects the conductive elements andsubstrate of the FPE assembly from the full impacts of externalmechanical forces within the body on the FPE assembly which occur duringnormal patient behavior.

In some examples, the FPE assembly 404 omits an interior shield element,such as second shield conductive element 517B (and outer insulator 520Bin FIG. 16), such that shielding functionality is provided on just oneside (e.g. the exterior portion) of the FPE assembly 404 such as viafirst shield conductive element 517A, such as shown in FIG. 7D.

In some examples, elongate support member 403 is omitted from leadassembly 1250.

FIG. 21C is a perspective view schematically representing an implantablelead assembly 1272 including the FPE assembly of FIG. 21B and includingan external shield in which a third FPE assembly 1270 has helicalwindings in an opposite orientation relative to the helical windings ofthe second FPE assembly 1260, according to one example of the presentdisclosure. In some examples, the lead assembly 1272 comprises at leastsubstantially the same features and attributes as the lead assembly 1250(FIG. 21B), except further comprising third FPE assembly 1270. Moreover,third FPE assembly 1270 comprises at least some of substantially thesame features and attributes as second FPE assembly 1260. However, FPEassembly 1270 has a larger inner diameter (D3 in FIG. 21D) than theinner diameter (D4 in FIG. 21D) of FPE assembly 1260, and FPE assembly1270 is oriented with its windings 1276 pointing in a non-paralleldirection diverging from an orientation of the windings 1266 of FPEassembly 1260. In some instances, this may be referred to oppositelyoriented windings. Via this arrangement, the respective FPE assemblies1260 and 1270 effectively form a mesh-like pattern, as further shown inFIG. 21D.

FIG. 21 D is partial top plan view schematically representing theopposite orientation of the helical windings 1266, 1276 of therespective second and third FPE assemblies 1260, 1270, according to oneexample of the present disclosure. Via this arrangement, the inductanceof the conductors may be increased, the capacitive coupling to bodytissue may be increased, thereby increasing the impedance of theconductor at high frequencies, forming a filter for RF energy.

FIG. 21E is a perspective view schematically representing an implantablelead assembly 1282, according to one example of the present disclosure.Lead assembly 1282 includes the FPE assembly 1260 of FIG. 21B and anexternal shield in which a third FPE assembly 1280 has helical windings1286 in generally the same orientation relative to the helical windings1266 of the second FPE assembly 1260, according to one example of thepresent disclosure. FIG. 21F is partial top plan view schematicallyrepresenting the generally same orientation of the helical windings1266, 1286 of the respective second and third FPE assemblies 1260, 1280,according to one example of the present disclosure.

In some examples, the lead assembly 1282 comprises at leastsubstantially the same features and attributes as the lead assembly 1250(FIG. 21B), except further comprising third FPE assembly 1280. Moreover,third FPE assembly 1280 comprises at least some of substantially thesame features and attributes as second FPE assembly 1260. However, FPEassembly 1280 has a larger inner diameter (D3 in FIG. 21F) than theinner diameter (D4 in FIG. 21F) of FPE assembly 1260. FPE assembly 1280is oriented with its windings 1286 pointing in the same direction (e.g.general parallel) as the windings 1266 of FPE assembly 1260.

Via this arrangement, the respective FPE assemblies 1260 and 1280effectively form an overlapping pattern, as further shown in FIG. 21F.In this pattern, the windings 1286 of one FPE assembly 1280 overlapswith the gaps between the windings 166 of the other FPE assembly 1260.In some examples, this arrangement of overlapping windings (having thesame orientation) may serve to increase the capacitive coupling to bodytissue, thereby increasing the impedance of the conductor at highfrequencies, forming a filter for RF energy.

FIG. 21F is top plan view of a FPE assembly 1370, according to oneexample of the present disclosure. In some examples, the FPE assembly1370 comprises an overlapping configuration like that of FPE assemblies1260, 1280 in FIGS. 20D-20E, except for being implemented via a singlehelically wound FPE assembly 1370 in which each winding partiallyoverlaps a preceding winding to eliminate gaps between the adjacentwindings. As shown in FIG. 21F, a first winding 1377 includes a firstedge 1378A and an opposite second edge 1378B, and each subsequentoverlapping windings 1376 include a first edge 1379A and an oppositesecond edge 1379B. In some examples, this arrangement of overlappingwindings (having the same orientation) may serve to increase thecapacitive coupling to body tissue, thereby increasing the impedance ofthe conductor at high frequencies, forming a filter for RF energy. Inone aspect, the overlapping windings 1376 effectively form a solidcolumn or tube of conductive material to enhance shielding of conductiveelements interior of the windings 1376.

FIG. 21H is a perspective view schematically representing an implantablelead assembly 1291, according to one example of the present disclosure.In some examples, the lead assembly 1291 comprises at leastsubstantially the same features and attributes as lead assembly 1250 inFIG. 21B, except for replacing the second FPE assembly 1260 with a coil1290 of conductive material helically wound about the tubular insulator1202. In some examples, coil 1290 comprises a wire or similar elongate,generally cylindrical structure having a relatively small diameter.However, in some examples instead of being a cylindrical structure, theadjacent conductive elements (e.g. windings) defining coil 1290 may beflat, mesh, etc.

In one aspect, the coil 1290 provides mechanical flex resistance toenhance overall reliability of the FPE assembly because the coil 1290protects the conductive elements and substrate of the FPE assembly fromthe full impacts of external mechanical forces within the body on theFPE assembly 404 which occur during normal patient behavior. However, insome examples, coil 1290 may provide greater flexibility and/orsimplicity than using a second FPE assembly 1260 as in the example ofFIG. 20.

In some examples, lead assembly 1291 omits elongate support member 403.

In one aspect, coil 1290 includes windings 1292 which are spaced apartby a distance G5. In some examples, the spacing G5 is at least one orderof magnitude less than a wavelength of the MRI-energy field signals(within the body). In some examples, the spacing G5 between adjacentwindings of coil 1290 is substantially smaller than a spacing G1 betweenadjacent windings of the FPE assembly 404.

In one aspect, the combination of a FPE assembly 404 and external coil1290 may provide numerous functions. For instance, as noted above, theFPE assembly 404 may enable more precise control over capacitivecoupling of the shielding component relative to the surrounding tissue.Moreover, in one aspect, this arrangement provides two independent MRIshielding layers to be incorporated into a single lead assembly 1291while minimizing a diameter of the lead assembly 1291. Accordingly, viathe particular configuration of the lead assembly 1291, this arrangementcould provide additional MR shielding to be incorporated into a leadassembly with many fewer components and with a much simpler leaddesign/manufacturing than prior commercial attempts at implementing MRIshielding into a lead assembly.

In some examples, the external coil 1290 is not physically coupled orelectrically coupled to the lead subassembly 1210 and outer tubularinsulator 1269 is omitted, such that the external coil 1290 maysometimes be referred to as a floating coil or a floating shield becauseit is separate from, and independent of, the lead subassembly 1210. Thisfreestanding coil 1290 can receive the MRI energy and dissipate theenergy over a large surface area via its direct contact with tissue. Inthis way, the coil 1290 acts as a shield or dissipating tool, which mayreduce the amount of MRI energy received at the conductive elements,such as but not limited to the relative small surface area electrodes ofthe lead assembly.

In some examples, such a floating external coil 1290 may include a thincoating to inhibit fibrotic tissue growth on the coil 1290 with thematerials selected so as to not significantly reduce the conductivity ofthe coil 1290 relative to the surrounding tissue to which the coil 1290is intended to be coupled. In some examples, such coatings can be madefrom a polytetrafluoroethylene (PTFE) material (e.g. a GORE-TEX®material), a conductive polyurethane tubing, a conductive siliconetubing, parylene, etc. In some examples, the coating can be a very thinnon-conductive tubing with some apertures to allow fluid ingress toestablish conductivity to the surrounding tissue, yet otherwise stillinhibit unwanted fibrotic tissue growth.

Via such coatings and/or tubing, the external coil 1290 may be explantedwith less difficulty than in the absence of such coatings or tubings.

FIG. 22A is a perspective view schematically representing an implantablelead assembly 1295, according to one example of the present disclosure.In some examples, the lead assembly 1295 comprises at least some ofsubstantially the same features and attributes as lead assembly 1291 inFIG. 21H, except for eliminating outermost tubular insulator 1269 andalso replacing or modifying coil 1290 of conductive material with a coil1293 (of windings 1294) which is wound about tubular insulator 1202. Insome examples, in this arrangement the coil 1293 is bonded to, and/orarranged within, an outer surface 1203 of tubular insulator 1202. Insome such examples, dip coating of the coil 1293 (such as via the dipcoating described in association with at least FIG. 21H) may facilitatebonding the coil 1293 relative to the outer surface 1203.

FIG. 22B is a perspective view schematically representing an implantablelead assembly 1300 including a FPE assembly 1304 extending through anouter tubular insulator 1302, according to one example of the presentdisclosure. In some examples, the FPE assembly 1304 comprises at leastsome of substantially the same features and attributes of an FPEassembly and/or lead assembly, as previously described in associationwith at least FIGS. 1-22B. For instance, the FPE assembly 1304 mayinclude signal conductive elements 514A, 514B (FIG. 7A-7E) such thatlead assembly 1300 may convey along its length a sensing and/orstimulation signal.

As in the prior examples, the FPE assembly 1304 includes one of themodalities 212, 214, 216, 217 of an attenuation arrangement 204. In someexamples, the FPE assembly 1304 may include shield conductive elements517A, 517B (FIG. 7A-7E) and in some examples, additionally includesadditional shielding components, as in at least some of the examplesthroughout FIGS. 10-33. Moreover, in some examples the FPE assembly 1304comprises inductive and/or capacitive attenuation elements 250, 252(FIG. 5A).

However, in the example of lead assembly 1300, the FPE assembly 1304 isnot provided in a helically wound configuration about an elongatesupport member 403 as in FIG. 6A. Instead, as shown in FIG. 22B, the FPEassembly 1304 defines the most central or core element of the leadassembly 1300 and the FPE assembly 1304 extends in an unwoundconfiguration as a straight elongate rectangular member. The outertubular insulator 1302 helps to protect the FPE assembly 1304 fromunwanted fibrotic growth, body fluids, etc. while also providing asmoother outer surface to facilitate insertion and advancement of leadassembly 1300 through body when implanting the lead assembly 1300. Insome examples, the outer tubular insulator 1302 may be formed with alarger wall thickness and/or relatively firm material (e.g. materialhardness) to provide at least some mechanical flex resistance to protectthe FPE assembly 1304. In some examples, such as when the FPE assembly1304 can include an outer surface having some exposed electricalconductive elements, such as in at least FIGS. 15-16, the outer tubularinsulator prevents direct coupling of such conductive elements with thesurrounding body tissue.

In one aspect, by providing the internal FPE assembly 1304 in an unwound(e.g. straight) configuration, manufacturing of the lead assembly 1300is simplified and a much shorter length of the FPE assembly 1304 isused, than if it were helically wound. Accordingly, this arrangementdecreases costs and use of material. In addition, providing the FPEassembly 1304 in a straight configuration provides a lower impedancepath for the signal conductive elements (e.g. 514A, 514B) than thehelically wound configuration.

In another aspect, via its straight configuration, the FPE assembly 1304offers shielding functionality for its signal conductive elements 514A,514B without adopting a coiled or helically wound configuration. Stateddifferently, overall formation of the lead assembly 1300 is greatlysimplified, yet shielding functionality is still achieved viaincorporating shielding and/or filtering functionality via printing theshielding components and relationships integrally within the FPEassembly 1304. As previously noted in connection with at least FIGS.6A-6B, 7E, the FPE assembly 1304 forms a monolithic structureincorporating both signal functionality and shielding functionality intoa single, unitary member.

In some examples, the FPE assembly 1304 may be longer than the outertubular insulator 1302 to facilitate flexing of the FPE assembly 1304,such as when implanting and/or maneuvering the lead assembly 1300. Insome such examples, this relationship may be achieved via the FPEassembly 1304 protruding from an end of the tubular insulator 1302and/or forming a portion of the FPE assembly 1304 (that extendswithin/through insulator 1302) to include at least one fold, undulation,etc. to enhance extensibility and/or flexing functionality for the FPEassembly 1304.

FIG. 23 is a perspective view schematically representing an implantablelead assembly 1350, according to one example of the present disclosure.In some examples, the lead assembly 1350 comprises at least some ofsubstantially the same features and attributes as lead assembly 1250 inFIG. 21B, except replacing the subassembly 1210 (including first FPEassembly 404, elongate support member 403, and tubular insulator 1202)with a lead subassembly 1310 (including FPE assembly 1304 and insulator1302). Via this arrangement, lead assembly 1350 includes a first FPEassembly 1304 and a second FPE assembly 1260. In comparison to the leadassembly 1150 in FIG. 20, the lead assembly 1350 in FIG. 23 comprises atleast substantially the same features except for having its internal FPEassembly 1304 being in an unwound configuration and with the FPEassembly 1304 defining the innermost component (e.g. the core) of thelead assembly 1350.

In some examples, in addition to FPE assembly 1260, an additional FPEassembly 1270 (FIG. 21C) or FPE assembly 1280 (FIG. 21D) is implementedin cooperation with FPE assembly 1260.

In some examples, the FPE assembly 1304 may be longer than the outertubular insulator 1302 to facilitate flexing of the FPE assembly 1304,such as when implanting and/or maneuvering the lead assembly 1300. Insome such examples, this relationship may be achieved via the FPEassembly 1304 protruding from an end of the tubular insulator 1302and/or forming a portion of the FPE assembly 1304 (that extendswithin/through insulator 1302) to include at least one fold, undulation,etc. to enhance extensibility and/or flexing functionality for the FPEassembly 1304.

FIG. 24 is a perspective view schematically representing an implantablelead assembly 1400, according to one example of the present disclosure.In some examples, the lead assembly 1400 comprises at leastsubstantially the same features and attributes as lead assembly 1350 inFIG. 23, except for replacing the second FPE assembly 1260 with a coil1410 like coil 1290 (FIG. 21H). In some examples, the lead assembly 1400shown in FIG. 24 also can be regarded as comprising at leastsubstantially the same features and attributes as lead assembly 1291 inFIG. 21H, except for replacing the lead subassembly 1210 (FIG. 21H) withlead subassembly 1310 (FIG. 23).

Via this arrangement, the coil 1410 provides an external shield whilethe FPE assembly 1304 may or may not include its own shielding and/orfiltering functionality as implemented according to the variousavailable modalities 212, 214, 216, 217 in FIG. 5A.

In some examples, lead assembly 1400 may be modified in a mannersubstantially the same as lead assembly 1295 (FIG. 22A) in which outertubular insulator 1269 is eliminated and coil 1410 is modified to bewound in contact against, and/or within an outer surface 1203, tubularinsulator 1203. Moreover, in some examples, the thickness (T10) of outertubular insulator 1269 and/or the gap G5 may be minimized in order toincrease capacitive coupling to body tissue, thereby enhancing shieldingof RF energy.

FIG. 25 is a perspective view schematically representing an implantablelead assembly 1500, according to one example of the present disclosure.In some examples, lead assembly 1500 includes a signal-carrying leadbody 1504 (e.g. 72 in FIG. 2) about which is helically wound a FPEassembly 1506.

In some examples, the FPE assembly 1506 acts as an external shield(shield modality 210 in FIG. 5A) via the FPE assembly 1506 incorporatingany or several of the attenuation modalities 212, 214, 216, 217 (FIG.5A) as implementable via any (or combinations thereof) of the exampleFPE assemblies as described throughout various examples of the presentdisclosure. For instance, in some examples, the FPE assembly 1506 mayinclude shield conductive elements 517A, 517B (FIG. 7A-7E) and in someexamples, additionally includes additional shielding components, as inFIGS. 10-12 and 15-18. Moreover, in some examples the FPE assembly 1506comprises inductive and/or capacitive attenuation elements 250, 252(FIG. 5A).

However, in some examples, the FPE assembly 1506 omits an interiorshield element, such as second shield conductive element 517B (and outerinsulator 520B in FIG. 16), such that shielding functionality isprovided on just one side (e.g. the exterior portion) of the FPEassembly such as via first shield conductive element 517A, as shown inFIG. 7D.

In addition, to the extent that the FPE assembly 1506 is constructedwith a spacing G6 that is sufficiently small, such as at least one orderof magnitude less than a wavelength of the MRI-energy field signals(within the body), then its helically wound configuration furtherenhances the attenuation functionality of FPE assembly 1506 relative tolead body 1504.

Meanwhile, the lead body 1504 is constructed without a FPE assembly, andincludes at least one signal conductive element extending a length ofthe lead body 1504 to convey a sensing signal and/or stimulation signaland includes at least an outer insulator.

At least some example implementations of lead body 1504 are provided inassociation with at least FIGS. 26-33.

FIG. 26 is a perspective view schematically representing a lead body1550, according to one example of the present disclosure. In someexamples, lead body 1550 comprises one example implementation of leadbody 1504 in FIG. 25. As shown in FIG. 26, lead body 1550 comprises asignal conductor 1552 in a coiled or helically wound configuration andextending within a lumen 1555 throughout a length of an outer tubularinsulator 1554. The signal conductor 1552 can convey sensing signalsand/or stimulation signals along the length of lead body 1550, such aslead 72 in FIG. 2.

In some examples, the signal conductor 1552 comprises a co-radialarrangement in which two different signal conductors 1553A, 1553B extendas part of the same coiled configuration, as further shown in thepartial sectional view of FIG. 27. As shown in FIG. 27, the respectivedifferent signal conductors 1553A, 15536 are in an interleaved (e.g.alternating) arrangement such that a single coil structure 1555 includestwo different (e.g. independent signal conductors). The respectivesignal conductors 1553A, 1553B can separately convey sensing signalsand/or stimulation signals along the length of lead body 1550, such aslead 72 in FIG. 2.

FIG. 28 is a perspective view schematically representing an implantablelead assembly 1570 including a lead body subassembly 1571 and anexternal coil shield 1572, according to one example of the presentdisclosure. In some examples, lead body subassembly 1571 comprises oneexample implementation of lead body 1504 in FIG. 25. As shown in FIG.28, lead assembly 1570 comprises the components of lead body 1550 inFIG. 26, and additionally comprises an external conductive coil 1572(e.g. helically wound configuration) wound about tubular insulator 1554and a second outer tubular insulator 1574. The external coil 1572corresponds to at least shield modality 210 of attenuation arrangement204 in FIG. 5A.

FIG. 29 is a sectional view schematically representing a lead body 1700,according to one example of the present disclosure. In some examples,lead body 1700 comprises one example implementation of lead body 1504(at least FIG. 25). As shown in FIG. 29, lead body 1700 includes a pairof signal conductive elements 1702A, 1702B arranged in a spaced apart,side by side arrangement such that signal conductive elements 1702A,1702B would extend side-by-side along a length of the lead body 1700. Insome examples, the spacing W5 between signal conductive elements 1702A,1720B is minimized in order to reduce the total cross-sectional areabetween them, which in turn, may reduce susceptibility to inductivecoupling of energy on to the signal conductive elements 1702A, 1702B. Insome examples, each signal conductive element 1702A, 1702B can take theform of a coil, such as but not limited to, the arrangement in FIG. 9.In some examples, the spacing between the conductive elements 1702A,1702B in three dimensions can be minimized in order to reduce the totalcross-sectional area between them.

FIG. 30 is a sectional view schematically representing a lead body 1750,according to one example of the present disclosure. In some examples,lead body 1750 comprises one example implementation of lead body 1504(at least FIG. 25). As shown in FIG. 30, lead body 1750 includes aninner signal conductive element 1752A and outer signal conductiveelement 1752B in a coaxial arrangement. In some examples, either or bothsignal conductive element 1752A, 1752B can take the form of a coil. Asshown in FIG. 30, in some examples, the inner signal conductive element1752A can take the form of a solid cylindrical member, and thereforehaving a generally circular cross-section as shown in FIG. 30.

FIG. 31A is a perspective view schematically representing an implantablelead assembly 1900, according to one example of the present disclosure.In some examples, lead assembly 1900 comprises a lead subassembly 1910(e.g. lead assembly 1500 in FIG. 25) and further comprises an outertubular insulator 1902 having an array 1920 of windows 1922A, 1922B,1922C. In one aspect, the presence of the outer tubular insulator 1902surrounding the lead subassembly 1910 may limit fibrotic tissue growthon FPE assembly 1506 and/or the lead body 1504, while the windows 1922A,1922B, 1922C make contact with surrounding body tissue to facilitatedissipation of energy generated from the MRI signals during MR scanning.

In some examples, at least some of the windows 1922A, 1922B, 1922C mayhave shapes (e.g. circular, triangular, etc.) other than the rectangularshaped shown in FIG. 31A.

In some examples, regardless of the particular shape, at least some ofthe windows 1922A, 1922B, 1922C may define area which is substantiallysmaller than shown in FIG. 31A, which may facilitate capacitivedispersion of RF energy. In some such examples, at least some of therespective windows would be too small to permit the arrangementdescribed and shown in FIG. 31B.

FIG. 31B is a sectional view schematically representing a relationshipof an outer surface of an external coil relative to a window of theouter flexible tubular insulator, according to one example of thepresent disclosure. In some examples, the arrangement 1940 shown in FIG.31B may correspond to one example implementation as taken along line 31Bof FIG. 31A. However, the arrangement 1940 in FIG. 31B is notnecessarily an exclusive representation of the arrangement in FIG. 31A.

As shown in FIG. 31B, at least some windings 1516 of FPE assembly 1506include a conductive protrusion 1950 sized and shaped to extend at leastpartially through one of the windows (e.g. 1922A) of outer tubularinsulator 1902 and beyond outer surface 1903 of outer tubular insulator1902. It will be understood that where multiple windows (e.g. 1922A,1922B, 1922C) are present, a respective protrusion 1950 may beimplemented for each window or for just some windows.

In some examples, the conductive protrusion 1950 is printed as part offormation of the FPE assembly 1506. In some examples, the conductiveprotrusion is secured to the outer surface of the FPE assembly 1506. Insome examples, the protrusion 1950 comprises an electrode.

In some examples, the arrangement includes at least one tab 1960 tofacilitate positioning the protrusion 1950 within and/or through the atleast one window (e.g. 1922A) and then to advance the protrusion 1950through the at least one window (e.g. 1922A). In some examples, the tab1960 is adhesively secured relative to the protrusion 1950 or onto thewinding 1516 of FPE assembly 1506 nearby the at least one protrusion1950.

In some examples, the tab 1960 and/or the protrusion 1950 are securedrelative to the outer surface of (one of the windings 1516) the FPEassembly 1506 via a very thin non-conductive sleeve.

FIG. 32 is a perspective view schematically representing an implantablelead assembly 2000, according to one example of the present disclosure.As shown in FIG. 32, in some examples lead assembly 2000 includes leadbody 1504 and an external coil 2010 defining a passage 2012 or lumenthrough which the lead body 1504 extends. The external coil 2010corresponds to at least the external shield modality 210 in theattenuation arrangement of FIG. 5A, and therefore acts to attenuateMRI-energy relative to the lead body 1504. In some examples, theexternal coil 2010 may be coated with a biocompatible, non-conductivematerial to minimize the introduction of additional conductive pathwaysand associated undesired electromagnetic interactions.

In some examples, the external coil 2010 may be implemented as twoopposing coils having at least some of substantially the same featuresand attributes as the outer coil 4610 and intermediate coil 4620 in FIG.20F.

FIG. 33 is a perspective view schematically representing an implantablelead assembly 2050, according to one example of the present disclosure.In some examples, lead assembly 2050 comprises substantially the samefeatures and attributes as lead assembly 2000 in FIG. 32, except furthercomprising an outer tubular insulator 1902 having substantially the samefeatures and attributes as the outer tubular insulator 1902 in FIG. 31.Accordingly, the outer tubular insulator 1902 may limit fibrotic growth,reduce tissue irritation, and improve lead handling and/or tunnelingcharacteristics on coil 2010 while windows 1922A, 1922B, 1922C permitdissipation of energy (resulting from MRI signals) into the surroundingbody tissue.

FIG. 34 is a flow diagram schematically representing a method 2400,according to one example of the present disclosure. In some examples, atleast some aspects of method 2400 may be implemented via at least someof the systems, devices, leads, assemblies, modalities, elements,structures, arrangements, functions, parameters, etc. as described inassociation with at least FIGS. 1-33. In some examples, at least someaspects of method 2400 may be implemented via at least some systems,devices, leads, assemblies, modalities, elements, structures,arrangements, functions, parameters, etc. other than those described inassociation with at least FIGS. 1-33.

In some examples, as shown at 2402 method 2400 comprises providing animplantable medical device having at least one signal conductor. At2404, method 2400 comprises arranging an attenuation arrangement inassociation with at least a portion of the implantable medical device toattenuate external RF energy. In some examples, one portion of theimplantable medical device (with which the attenuation arrangement isassociated) comprises a lead, such as a lead extendible between twoother elements, such as an implantable electrode and an implantablemonitor and/or pulse generator. In some examples, the implantablemedical device (with which the attenuation arrangement is associated)comprises an electrode, which may comprise at least one electrodecontact. The electrode may be for sensing and/or stimulation. In someexamples, the implantable medical device (with which the attenuationarrangement is associated) comprises a monitor and/or pulse generator.In some examples, the implantable medical device comprises a combinationof the lead, electrode, and pulse generator (or monitor). FIG. 35 is aflow diagram schematically representing a method 2500, according to oneexample of the present disclosure.

In some examples, at least some aspects of method 2500 may beimplemented via at least some of the systems, devices, leads,assemblies, modalities, elements, structures, arrangements, functions,parameters, etc. as described in association with at least FIGS. 1-34.In some examples, at least some aspects of method 2500 may beimplemented via at least some systems, devices, leads, assembliesmodalities, elements, structures, arrangements, functions, parameters,etc. other than those described in association with at least FIGS. 1-34.

In some examples, method 2500 comprises at least some of substantiallythe same features and attributes as method 2400 (FIG. 34) and comprisesone example implementation of at least some aspects of method 2400.

In some examples, at 2502 method 2500 comprises implanting animplantable medical device having at least one signal conductor. In someexamples, the implantable medical device may comprise a lead, electrode,and/or pulse generator, such as previously described in association withat least FIG. 34.

In some examples, at 2504 method 2500 comprises attenuating external RFenergy relative to at least the at least one signal conductor of theimplantable medical device.

In some examples, the attenuating of external RF energy may beimplemented via shielding RF energy (at 2512), filtering or dissipatingRF energy (at 2514), and/or via anti-phase cancellation of RF energy (at2516). In some examples, such implementation may occur via at least someof the aspects described in association with at least FIGS. 5A-5D, andmore specific implementations described in association with at leastFIGS. 6A-33.

In some examples, the shielding of RF energy (2512) may be implementedexternally to the implantable medical device (at 2522) and/orimplemented internally within the implantable medical device (at 2524).

In some examples, the attenuating of external RF energy (at 2504) may beimplemented via flexible printed electronics (FPE), such as via at leastsome aspects of the various FPE arrangements described throughout thepresent disclosure. However, in some examples, the attenuating ofexternal RF energy (at 2504) may be implemented via arrangements (asdescribed throughout examples of the present disclosure) other thanflexible printed electronics (FPE). In some examples, the attenuating ofexternal RF energy may be implemented via a combination of flexibleprinted electronics (FPE) and non-FPE arrangements.

Although specific examples have been illustrated and described herein, avariety of alternate and/or equivalent implementations may besubstituted for the specific examples shown and described withoutdeparting from the scope of the present disclosure. This application isintended to cover any adaptations or variations of the specific examplesdiscussed herein.

1. An implantable lead assembly comprising: a lead including a firstelongate flexible printed electronic assembly, which includes a firstsignal conductive element; and at least one attenuation arrangement toattenuate MRI-energy, wherein the at least one attenuation arrangementincludes a first portion formed as part of the elongate flexible printedelectronic assembly, and wherein the first portion is separate from, andindependent of, the first signal conductive element in the elongateflexible printed electronic assembly.